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General NPI Number Information
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NPI Number | 1962609263
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Entity Type | Individual
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Provider Name | SHANNON ELIZABETH CARTER PH.D.
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Gender | Female
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Dates
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Enumeration Date | 06/29/2007
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Last Update Date | 10/30/2008
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Provider Practice Location Address
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Address Line | 235 S MAITLAND AVE SUITE 100
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City | MAITLAND
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State | FL
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Zip | 32751-5677
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Country | US
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Telephone | 407-628-5354
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 947785
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City | MAITLAND
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State | FL
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Zip | 32794-7785
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Country | US
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Telephone | 407-212-0910
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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 | PY7823
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License Number State | FL
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