MEDICARE: SHANICE J KEITH

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		FL

General Provider Information

NPI Number	:	1841067469
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANICE J KEITH

Provider Business Mailing Address
First Line	:	4156 COVINGTON ST
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32811-5027
Country	:	US
Telephone Number	:	407-761-4760
Fax Number	:

Provider Business Practice Location Address
First Line	:	2007 MAPLE RIDGE DR
Second Line	:
City	:	ZELLWOOD
State	:	FL
Zip	:	32798-5420
Country	:	US
Telephone Number	:	407-761-4760
Fax Number	:

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

Provider Enumeration Date	:	12/04/2023
Last Update Date	:	12/04/2023

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Directions to “ SHANICE J KEITH ” Practice Location

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