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General NPI Number Information
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NPI Number | 1033419361
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Entity Type | Individual
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Provider Name | LATONYA DENISE SHAW M.S
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Gender | Female
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Dates
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Enumeration Date | 11/03/2010
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Last Update Date | 08/02/2023
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Provider Practice Location Address
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Address Line | 405 SEAFOAM CIR
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City | FORT PIERCE
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State | FL
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Zip | 34945-1203
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Country | US
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Telephone | 561-294-5888
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 881147
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City | PORT ST LUCIE
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State | FL
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Zip | 34988-1147
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Country | US
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Telephone | 561-294-5888
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MH22407
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License Number State | FL
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