Provider Demographics
NPI:1619220969
Name:WHITE, SHANNA LEIGH (MS)
Entity Type:Individual
Prefix:
First Name:SHANNA
Middle Name:LEIGH
Last Name:WHITE
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 1:5045 CARPENTER CREEK DR
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-2521
Mailing Address - Country:US
Mailing Address - Phone:850-377-7121
Mailing Address - Fax:888-249-2325
Practice Address - Street 1:5045 CARPENTER CREEK DR
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-2521
Practice Address - Country:US
Practice Address - Phone:850-377-7121
Practice Address - Fax:888-249-2325
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-24
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL101198100Medicaid