Provider Demographics
NPI:1578296976
Name:LOMBARDI, SHANNON (MS)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:LOMBARDI
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1807 NE 26TH TER
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33909-4594
Mailing Address - Country:US
Mailing Address - Phone:863-450-0362
Mailing Address - Fax:
Practice Address - Street 1:17595 S TAMIAMI TRL STE 265C
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-4884
Practice Address - Country:US
Practice Address - Phone:941-549-8617
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-05
Last Update Date:2022-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL22627101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health