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General NPI Number Information
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NPI Number | 1457270134
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Entity Type | Individual
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Provider Name | FANTASHA SOLOMON
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Gender | Female
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Dates
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Enumeration Date | 07/15/2026
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Last Update Date | 07/15/2026
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Provider Practice Location Address
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Address Line | 525 TECHNOLOGY PARK STE 109
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City | LAKE MARY
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State | FL
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Zip | 32746-7107
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Country | US
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Telephone | 321-732-5617
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Fax |
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Provider Business Mailing Address
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Address Line | 1010 MONROE ST APT A
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City | LAKELAND
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State | FL
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Zip | 33801-5606
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Country | US
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Telephone |
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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 | 103TB0200X
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Taxonomy Name | Cognitive & Behavioral Psychologist
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License Number |
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License Number State |
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