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General NPI Number Information
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NPI Number | 1750198313
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Entity Type | Individual
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Provider Name | SHANNON LEIGH LCSW
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Gender | Female
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Dates
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Enumeration Date | 12/16/2024
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Last Update Date | 10/29/2025
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Provider Practice Location Address
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Address Line | 926 CYPRESS VILLAGE BLVD STE B
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City | RUSKIN
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State | FL
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Zip | 33573-6831
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Country | US
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Telephone | 239-690-6906
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Fax |
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Provider Business Mailing Address
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Address Line | 5914 118TH TER E
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City | PARRISH
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State | FL
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Zip | 34219-5839
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Country | US
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Telephone | 240-888-1201
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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 | SW12537
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License Number State | FL
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