Provider Demographics
NPI:1194380006
Name:MILES, SHAWNETTE (MSW)
Entity Type:Individual
Prefix:
First Name:SHAWNETTE
Middle Name:
Last Name:MILES
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2355 W MICHIGAN AVE APT E10
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32526-2326
Mailing Address - Country:US
Mailing Address - Phone:850-361-8967
Mailing Address - Fax:
Practice Address - Street 1:112 W CERVANTES ST
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32501-3128
Practice Address - Country:US
Practice Address - Phone:850-361-8967
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-06
Last Update Date:2020-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL135281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical