MEDICARE: CAROL SHIRKEY C.A.P.

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	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1780089557
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROL SHIRKEY C.A.P.

Provider Business Mailing Address
First Line	:	4678 TAMIAMI TRL UNIT 105
Second Line	:
City	:	PORT CHARLOTTE
State	:	FL
Zip	:	33980-2900
Country	:	US
Telephone Number	:	941-979-5023
Fax Number	:	941-979-5064

Provider Business Practice Location Address
First Line	:	4678 TAMIAMI TRL UNIT 105
Second Line	:
City	:	PORT CHARLOTTE
State	:	FL
Zip	:	33980-2900
Country	:	US
Telephone Number	:	941-979-5023
Fax Number	:	941-979-5064

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

Provider Enumeration Date	:	10/23/2014
Last Update Date	:	10/23/2014

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Directions to “ CAROL SHIRKEY C.A.P.” Practice Location

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