MEDICARE: KRISHAWNA ERICA SHEARER CMHC INTERN

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	:	1154063451
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISHAWNA ERICA SHEARER CMHC INTERN

Provider Business Mailing Address
First Line	:	867 SHEOAH CIR
Second Line	:
City	:	WINTER SPRINGS
State	:	FL
Zip	:	32708-2011
Country	:	US
Telephone Number	:	407-283-3338
Fax Number	:

Provider Business Practice Location Address
First Line	:	1701 PARK CENTER DRIVE, SUITE 210
Second Line	:	1701 PARK CENTER DRIVE, SUITE 210
City	:	ORLANDO
State	:	FL
Zip	:	32835-3283
Country	:	US
Telephone Number	:	407-730-3837
Fax Number	:

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

Provider Enumeration Date	:	04/08/2022
Last Update Date	:	04/08/2022

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