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General NPI Number Information
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NPI Number | 1891338307
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Entity Type | Individual
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Provider Name | KEVIN B SHACKET PSYD
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Gender | Male
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Dates
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Enumeration Date | 10/28/2019
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Last Update Date | 03/31/2025
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Provider Practice Location Address
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Address Line | 3298 SUMMIT BLVD BLDG 22, SUITE D1
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City | PENSACOLA
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State | FL
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Zip | 32503
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Country | US
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Telephone | 850-366-3627
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Fax | 850-662-0511
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Provider Business Mailing Address
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Address Line | 781 CONNELL DR
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City | PENSACOLA
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State | FL
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Zip | 32503-4234
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Country | US
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Telephone | 321-303-9593
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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 | PY10532
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License Number State | FL
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