Provider Demographics
NPI:1568103323
Name:FLOYD, SHANTELLA
Entity Type:Individual
Prefix:
First Name:SHANTELLA
Middle Name:
Last Name:FLOYD
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 1:1135 NW 23RD AVE STE D
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32609-3449
Mailing Address - Country:US
Mailing Address - Phone:135-233-9584
Mailing Address - Fax:352-240-3919
Practice Address - Street 1:1135 NW 23RD AVE STE D
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32609-3449
Practice Address - Country:US
Practice Address - Phone:135-233-9584
Practice Address - Fax:352-240-3919
Is Sole Proprietor?:No
Enumeration Date:2022-04-05
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health