MEDICARE: SONDA HAWLEY SHANK LCSW

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	1041C0700X	Clinical Social Worker	C001811	NC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00106580	OTHER	NC	RR MEDICARE # - PARADIGM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1740375427
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SONDA HAWLEY SHANK LCSW

Provider Business Mailing Address
First Line	:	13575 58TH ST N
Second Line	:	SUITE 190
City	:	CLEARWATER
State	:	FL
Zip	:	33760-3740
Country	:	US
Telephone Number	:	800-632-6074
Fax Number	:

Provider Business Practice Location Address
First Line	:	3125 POPLARWOOD CT
Second Line	:	THE ASPEN BLDG STE 100
City	:	RALEIGH
State	:	NC
Zip	:	27604-1084
Country	:	US
Telephone Number	:	800-632-6074
Fax Number	:	866-341-7509

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

Provider Enumeration Date	:	10/04/2006
Last Update Date	:	12/10/2012

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Directions to “ SONDA HAWLEY SHANK LCSW” Practice Location

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