MEDICARE: SIERRA A SHANNON

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	:	1184322141
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SIERRA A SHANNON

Provider Business Mailing Address
First Line	:	873 10TH AVE S
Second Line	:
City	:	SAINT PETERSBURG
State	:	FL
Zip	:	33701-4725
Country	:	US
Telephone Number	:	540-846-4366
Fax Number	:

Provider Business Practice Location Address
First Line	:	4520 OAK FAIR BLVD
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33610-7356
Country	:	US
Telephone Number	:	813-542-5500
Fax Number	:

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

Provider Enumeration Date	:	02/20/2023
Last Update Date	:	02/20/2023

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Directions to “ SIERRA A SHANNON ” Practice Location

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