Provider Demographics
NPI:1104180280
Name:BARSEMA, SHANNON MARIE (PHD)
Entity Type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:MARIE
Last Name:BARSEMA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:SHANNON
Other - Middle Name:MARIE
Other - Last Name:FOSTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:430 MORTON PLANT ST STE 401
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33756-3394
Mailing Address - Country:US
Mailing Address - Phone:727-298-6025
Mailing Address - Fax:727-461-8648
Practice Address - Street 1:430 MORTON PLANT ST
Practice Address - Street 2:SUITE 402
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-3398
Practice Address - Country:US
Practice Address - Phone:727-461-8635
Practice Address - Fax:727-333-6038
Is Sole Proprietor?:No
Enumeration Date:2012-07-03
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY 9339103TA0700X, 103TC0700X, 103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & Aging
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP01713937OtherRAILROAD MEDICARE PROVIDER NUMBER
FL023608600Medicaid