Provider Demographics
NPI:1376816074
Name:STOWITZKY, SHANA LYNN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:SHANA
Middle Name:LYNN
Last Name:STOWITZKY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4100 W KENNEDY BLVD STE 212
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33609-2244
Mailing Address - Country:US
Mailing Address - Phone:312-316-1391
Mailing Address - Fax:
Practice Address - Street 1:4100 W KENNEDY BLVD STE 212
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-2244
Practice Address - Country:US
Practice Address - Phone:312-316-1391
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-12
Last Update Date:2015-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY8475103TC0700X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical