Provider Demographics
NPI:1639521032
Name:MANICCIA, SHELBY (MA)
Entity Type:Individual
Prefix:
First Name:SHELBY
Middle Name:
Last Name:MANICCIA
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:513 ALAFAYA WOODS BLVD
Mailing Address - Street 2:APT H
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-5519
Mailing Address - Country:US
Mailing Address - Phone:407-766-6690
Mailing Address - Fax:
Practice Address - Street 1:513 ALAFAYA WOODS BLVD
Practice Address - Street 2:APT H
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-5519
Practice Address - Country:US
Practice Address - Phone:407-766-6690
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-08
Last Update Date:2016-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health