Healthcare Provider Details

I. General information

NPI: 1922235290
Provider Name (Legal Business Name): SHANNA RHEA PRESTON ALLEN M.A. CCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2009
Last Update Date: 07/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35015 MEADOW REACH DR
ZEPHYRHILLS FL
33541
US

IV. Provider business mailing address

35015 MEADOW REACH DR
ZEPHYRHILLS FL
33541-1964
US

V. Phone/Fax

Practice location:
  • Phone: 813-415-9653
  • Fax:
Mailing address:
  • Phone: 813-415-9653
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number3800
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number09-049
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSA12638
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: