MEDICARE: DR. SHAWN RAE SORENSEN PH.D.

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	103TC0700X	Clinical Psychologist	PY0003676	FL

General Provider Information

NPI Number	:	1093719064
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHAWN RAE SORENSEN PH.D.

Provider Business Mailing Address
First Line	:	PO BOX 1380
Second Line	:
City	:	STUART
State	:	FL
Zip	:	34995-1380
Country	:	US
Telephone Number	:	772-692-4410
Fax Number	:	772-692-4508

Provider Business Practice Location Address
First Line	:	400 NW DIXIE HWY.
Second Line	:
City	:	STUART
State	:	FL
Zip	:	34994
Country	:	US
Telephone Number	:	772-692-4410
Fax Number	:	772-692-4508

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

Provider Enumeration Date	:	06/08/2005
Last Update Date	:	10/03/2022

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