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General NPI Number Information
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NPI Number | 1538835558
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Entity Type | Individual
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Provider Name | KEISHA SHERRIE POLONIO LCSW
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Gender | Female
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Dates
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Enumeration Date | 08/19/2021
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Last Update Date | 10/02/2024
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Provider Practice Location Address
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Address Line | 1210 MILLENNIUM PKWY STE 1031
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City | BRANDON
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State | FL
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Zip | 33511-4859
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Country | US
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Telephone | 813-665-0235
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Fax | 813-560-0452
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Provider Business Mailing Address
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Address Line | 11126 S US HIGHWAY 41 UNIT 2054
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City | GIBSONTON
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State | FL
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Zip | 33534-9794
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Country | US
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Telephone | 813-665-0235
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | SW23221
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License Number State | FL
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