Provider Demographics
NPI:1205856184
Name:CAPEN, SHANNA LEA GUSTAFSON (MS, MPH, CGC)
Entity Type:Individual
Prefix:
First Name:SHANNA
Middle Name:LEA GUSTAFSON
Last Name:CAPEN
Suffix:
Gender:F
Credentials:MS, MPH, CGC
Other - Prefix:
Other - First Name:SHANNA
Other - Middle Name:
Other - Last Name:GUSTAFSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS, MPH, CGC
Mailing Address - Street 1:360 CENTRAL AVE
Mailing Address - Street 2:SUITE 1230
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-3857
Mailing Address - Country:US
Mailing Address - Phone:800-975-4819
Mailing Address - Fax:760-203-1194
Practice Address - Street 1:360 CENTRAL AVE
Practice Address - Street 2:SUITE 1230
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-3857
Practice Address - Country:US
Practice Address - Phone:800-975-4819
Practice Address - Fax:760-203-1194
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2016-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS