Provider Demographics
NPI:1093964421
Name:LOSETO, SHANNON PEARSALL (BA)
Entity Type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:PEARSALL
Last Name:LOSETO
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8961 DANIELS CENTER DR
Mailing Address - Street 2:SUITE 401
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33912-0314
Mailing Address - Country:US
Mailing Address - Phone:239-433-6700
Mailing Address - Fax:239-433-6706
Practice Address - Street 1:8961 DANIELS CENTER DR
Practice Address - Street 2:SUITE 401
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-0314
Practice Address - Country:US
Practice Address - Phone:239-433-6700
Practice Address - Fax:239-433-6706
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-10
Last Update Date:2010-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLITDS222Q00000X
104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist