Provider Demographics
NPI:1568944916
Name:BRINNIUS, SHANTEL
Entity Type:Individual
Prefix:
First Name:SHANTEL
Middle Name:
Last Name:BRINNIUS
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 1:799 PANICAL DR
Mailing Address - Street 2:
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32703
Mailing Address - Country:US
Mailing Address - Phone:321-444-9346
Mailing Address - Fax:
Practice Address - Street 1:2479 ALOMA AVE. 32792
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32703
Practice Address - Country:US
Practice Address - Phone:321-947-0215
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-02
Last Update Date:2018-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical