Provider Demographics
NPI:1598046286
Name:DIXON, PATRICIA SHALENE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:SHALENE
Last Name:DIXON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:975 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:PALMETTO
Mailing Address - State:FL
Mailing Address - Zip Code:34221-5044
Mailing Address - Country:US
Mailing Address - Phone:941-479-7866
Mailing Address - Fax:941-479-7867
Practice Address - Street 1:975 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:PALMETTO
Practice Address - State:FL
Practice Address - Zip Code:34221-5044
Practice Address - Country:US
Practice Address - Phone:941-479-7866
Practice Address - Fax:941-479-7867
Is Sole Proprietor?:No
Enumeration Date:2011-09-08
Last Update Date:2019-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY8356103TP2701X, 103TC0700X, 103TC2200X, 103TA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLT092120110000538Medicare PIN
1790068344Medicare PIN