MEDICARE: SHANNON HELLER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1013645910
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANNON HELLER

Provider Business Mailing Address
First Line	:	PO BOX 7686
Second Line	:
City	:	SEMINOLE
State	:	FL
Zip	:	33775-7686
Country	:	US
Telephone Number	:	813-670-3411
Fax Number	:

Provider Business Practice Location Address
First Line	:	6938 W LINEBAUGH AVE STE 101
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33625-5824
Country	:	US
Telephone Number	:	813-670-3411
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/10/2022
Last Update Date	:	08/10/2022

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Directions to “ SHANNON HELLER ” Practice Location

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