Provider Demographics
NPI:1619533130
Name:PARRINELLO, SHANNON NICOLLE
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:NICOLLE
Last Name:PARRINELLO
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 1:3927 SW 17TH AVE
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33914-5670
Mailing Address - Country:US
Mailing Address - Phone:239-265-0586
Mailing Address - Fax:
Practice Address - Street 1:1404 DEL PRADO BLVD S STE 135
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33990-3782
Practice Address - Country:US
Practice Address - Phone:239-265-0586
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-10
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
FLIMH24291101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician