MEDICARE: SHANTEL PARKER

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	MH17292	FL
2	103K00000X	Behavior Analyst		FL

General Provider Information

NPI Number	:	1982315024
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANTEL PARKER

Provider Business Mailing Address
First Line	:	4708 W PRICE AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33611-3347
Country	:	US
Telephone Number	:	813-368-1808
Fax Number	:

Provider Business Practice Location Address
First Line	:	4708 W PRICE AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33611-3347
Country	:	US
Telephone Number	:	813-368-1808
Fax Number	:

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

Provider Enumeration Date	:	12/09/2022
Last Update Date	:	08/25/2023

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Directions to “ SHANTEL PARKER ” Practice Location

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