Provider Demographics
NPI:1215224472
Name:ST JUSTE, SHIRLEY (NCC, EDS, MED,)
Entity Type:Individual
Prefix:MS
First Name:SHIRLEY
Middle Name:
Last Name:ST JUSTE
Suffix:
Gender:F
Credentials:NCC, EDS, MED,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5000-18 HWY 17 SOUTH #244
Mailing Address - Street 2:
Mailing Address - City:FLEMING ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32003
Mailing Address - Country:US
Mailing Address - Phone:904-775-2054
Mailing Address - Fax:904-672-3377
Practice Address - Street 1:2233 PARK AVE STE 201D
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-5567
Practice Address - Country:US
Practice Address - Phone:904-775-2054
Practice Address - Fax:904-672-3377
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional