MEDICARE: SHANTERICA LATRICE SWAN

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	IMH24922	FL

General Provider Information

NPI Number	:	1184586042
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANTERICA LATRICE SWAN

Provider Business Mailing Address
First Line	:	9555 SW 175TH TER # 4011
Second Line	:
City	:	PALMETTO BAY
State	:	FL
Zip	:	33157-5604
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9555 SW 175TH TER # 4011
Second Line	:
City	:	PALMETTO BAY
State	:	FL
Zip	:	33157-5604
Country	:	US
Telephone Number	:	786-862-6699
Fax Number	:

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

Provider Enumeration Date	:	12/01/2025
Last Update Date	:	12/01/2025

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Directions to “ SHANTERICA LATRICE SWAN ” Practice Location

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