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General NPI Number Information
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NPI Number | 1770056384
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Entity Type | Organization
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Legal Business Name | SHANE LYNN ( S&D BEHAVIORAL HEALTH)
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Dates
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Enumeration Date | 01/07/2019
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Last Update Date | 12/03/2021
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Provider Practice Location Address
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Address Line | 2710 ALTERNATE 19 N 403B
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City | PALM HARBOR
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State | FL
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Zip | 34683-3203
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Country | US
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Telephone | 727-275-3601
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Fax |
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Provider Business Mailing Address
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Address Line | 2710 ALTERNATE 19 N 403B
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City | PALM HARBOR
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State | FL
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Zip | 34683-3203
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Country | US
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Telephone | 727-275-3601
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Fax |
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Authorized Official
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Title or Position | PSYCHIATRIC NURSE PRACTITIONER
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Name | SHANE LYNN
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Credential | ARNP
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Telephone | 727-641-4435
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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