MEDICARE: LATASHA SHEFFIELD

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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
2	103TC1900X	Counseling Psychologist

General Provider Information

NPI Number	:	1689267379
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LATASHA SHEFFIELD

Provider Business Mailing Address
First Line	:	4123 COLUMBIA ST
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32811-4627
Country	:	US
Telephone Number	:	407-486-0302
Fax Number	:

Provider Business Practice Location Address
First Line	:	4123 COLUMBIA ST
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32811-4627
Country	:	US
Telephone Number	:	407-486-0302
Fax Number	:

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

Provider Enumeration Date	:	02/15/2021
Last Update Date	:	02/15/2021

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