Provider Demographics
NPI:1346502069
Name:SHAWN L. ZIMMERMAN, PHD, LLC
Entity Type:Organization
Organization Name:SHAWN L. ZIMMERMAN, PHD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:ZIMMERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:407-580-6997
Mailing Address - Street 1:549 N WYMORE RD
Mailing Address - Street 2:SUITE 209
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-4203
Mailing Address - Country:US
Mailing Address - Phone:407-580-6997
Mailing Address - Fax:407-628-9437
Practice Address - Street 1:549 N WYMORE RD
Practice Address - Street 2:SUITE 209
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-4203
Practice Address - Country:US
Practice Address - Phone:407-580-6997
Practice Address - Fax:407-628-9437
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-08
Last Update Date:2012-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 9575251S00000X
COPSYCHOLOGIST 2721251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health