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General NPI Number Information
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NPI Number | 1598785032
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Entity Type | Individual
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Provider Name | STORNE L SHIVELY PHD
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Gender | Female
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Dates
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Enumeration Date | 07/20/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 7895C PENSACOLA BLVD
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City | PENSACOLA
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State | FL
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Zip | 32534-4248
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Country | US
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Telephone | 850-471-7691
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Fax | 850-471-7759
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Provider Business Mailing Address
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Address Line | 135 INGALLS DR
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City | PENSACOLA
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State | FL
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Zip | 32506-5258
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Country | US
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Telephone | 850-455-2754
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PY 6000
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License Number State | FL
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