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NPI Code Detail

MEDICARE: SHANTELL M COHEN

MEDICARE: SHANTELL M COHEN
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
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1174668610
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHANTELL M COHEN
Provider Business Mailing Address
First Line : 3890 DUNN AVE STE 1104
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32218-6432
Country : US
Telephone Number : 904-765-0665
Fax Number : 904-765-0664
Provider Business Practice Location Address
First Line : 3890 DUNN AVE STE 1104
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32218-6432
Country : US
Telephone Number : 904-765-0665
Fax Number : 904-765-0664
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/21/2007
Last Update Date : 10/05/2020

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Directions to “ SHANTELL M COHEN ” Practice Location

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