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NPI Code Detail

MEDICARE: MRS. SHANNON PEARSALL LOSETO BA

MEDICARE: MRS. SHANNON PEARSALL LOSETO BA
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
1104100000XSocial Worker
2222Q00000XDevelopmental TherapistITDSFL

General Provider Information

NPI Number : 1093964421
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. SHANNON PEARSALL LOSETO BA
Provider Business Mailing Address
First Line : 12220 TOWNE LAKE DR STE 1
Second Line :
City : FORT MYERS
State : FL
Zip : 33913-8021
Country : US
Telephone Number : 239-433-6700
Fax Number : 239-433-6706
Provider Business Practice Location Address
First Line : 12220 TOWNE LAKE DR STE 1
Second Line :
City : FORT MYERS
State : FL
Zip : 33913-8021
Country : US
Telephone Number : 239-433-6700
Fax Number : 239-433-6706
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/10/2008
Last Update Date : 04/06/2026

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Directions to “ MRS. SHANNON PEARSALL LOSETO BA” Practice Location

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