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General NPI Number Information
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NPI Number | 1528833597
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Entity Type | Individual
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Provider Name | SHELLEY BUCHANAN
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Gender | Female
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Dates
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Enumeration Date | 11/20/2023
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Last Update Date | 11/20/2023
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Provider Practice Location Address
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Address Line | 4156 INVERRARY DR APT 109
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City | LAUDERHILL
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State | FL
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Zip | 33319-4537
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Country | US
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Telephone | 954-486-5967
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Fax |
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Provider Business Mailing Address
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Address Line | 1323 SE 17TH ST UNIT 91517
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City | FT LAUDERDALE
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State | FL
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Zip | 33316-1707
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Country | US
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Telephone | 954-486-5967
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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 | MH12404
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License Number State | FL
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