Provider Demographics
NPI:1376592527
Name:SHANNON, DEBORAH L
Entity Type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:L
Last Name:SHANNON
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:DEBORAH
Other - Middle Name:L
Other - Last Name:ZOLL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:108 JAMAICA DR
Mailing Address - Street 2:
Mailing Address - City:COCOA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32931-3213
Mailing Address - Country:US
Mailing Address - Phone:407-920-2344
Mailing Address - Fax:321-799-1109
Practice Address - Street 1:1980 N ATLANTIC AVE
Practice Address - Street 2:SUITE 515
Practice Address - City:COCOA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32931-5213
Practice Address - Country:US
Practice Address - Phone:321-501-2328
Practice Address - Fax:321-799-1109
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2015-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW25511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ6252OtherBCBS
FLZ6252OtherBCBS