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General NPI Number Information
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NPI Number | 1487428108
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Entity Type | Individual
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Provider Name | NIKITA SHINN
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Gender | Female
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Dates
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Enumeration Date | 11/13/2023
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Last Update Date | 11/13/2023
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Provider Practice Location Address
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Address Line | 435 S RIDGEWOOD AVE STE 204C-205
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City | DAYTONA BEACH
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State | FL
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Zip | 32114-4927
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Country | US
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Telephone | 305-282-5167
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Fax |
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Provider Business Mailing Address
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Address Line | 601 BILL FRANCE BLVD APT 702
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City | DAYTONA BEACH
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State | FL
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Zip | 32114-1310
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Country | US
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Telephone | 305-282-5167
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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