Provider Demographics
NPI:1407175722
Name:MATHEW, SHIMI MANOJ (APRN, PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:SHIMI
Middle Name:MANOJ
Last Name:MATHEW
Suffix:
Gender:F
Credentials:APRN, PMHNP-BC
Other - Prefix:
Other - First Name:SHIMI
Other - Middle Name:
Other - Last Name:JOSEPH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:2013 LIVE OAK BLVD STE B&C
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:FL
Mailing Address - Zip Code:34771-8408
Mailing Address - Country:US
Mailing Address - Phone:407-593-2388
Mailing Address - Fax:
Practice Address - Street 1:2013 LIVE OAK BLVD STE B&C
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:FL
Practice Address - Zip Code:34771-8408
Practice Address - Country:US
Practice Address - Phone:407-593-2388
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-26
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11029483363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health