Provider Demographics
NPI:1538461462
Name:SCHLISSEL, SHANNON L
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:L
Last Name:SCHLISSEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:521 W STATE ROUTE 434
Mailing Address - Street 2:SUITE 204
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32750
Mailing Address - Country:US
Mailing Address - Phone:407-767-5842
Mailing Address - Fax:321-842-0186
Practice Address - Street 1:521 W STATE ROUTE 434
Practice Address - Street 2:SUITE 204
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32750-2008
Practice Address - Country:US
Practice Address - Phone:407-767-5842
Practice Address - Fax:321-842-0186
Is Sole Proprietor?:No
Enumeration Date:2010-11-29
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL23809225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist