Provider Demographics
NPI:1073892840
Name:RADAY, SHANNON (MASTERS LEVEL)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:RADAY
Suffix:
Gender:F
Credentials:MASTERS LEVEL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2433 S MYRTLE AVE
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32771-4448
Mailing Address - Country:US
Mailing Address - Phone:727-432-4367
Mailing Address - Fax:727-210-6945
Practice Address - Street 1:1437 S BELCHER RD
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33764-2829
Practice Address - Country:US
Practice Address - Phone:727-524-4464
Practice Address - Fax:727-210-6945
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-11
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA8980101YM0800X
AZ22147101YM0800X
FL12548101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty