Provider Demographics
NPI:1083015655
Name:ANTHONY, SHYNEA (MS)
Entity Type:Individual
Prefix:
First Name:SHYNEA
Middle Name:
Last Name:ANTHONY
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9727 TRANQUILITY LAKE CIR APT 107
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33578-4011
Mailing Address - Country:US
Mailing Address - Phone:863-272-0279
Mailing Address - Fax:
Practice Address - Street 1:12642 ADVENTURE DR
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33579-7790
Practice Address - Country:US
Practice Address - Phone:863-272-0279
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-15
Last Update Date:2022-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health