Provider Demographics
NPI:1679000947
Name:AGUILAR, SHANNON LEE (MSW, RCSWI)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:LEE
Last Name:AGUILAR
Suffix:
Gender:F
Credentials:MSW, RCSWI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13542 N FLORIDA AVE STE 210
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33613-3263
Mailing Address - Country:US
Mailing Address - Phone:813-390-4340
Mailing Address - Fax:
Practice Address - Street 1:13542 N FLORIDA AVE STE 210
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-3263
Practice Address - Country:US
Practice Address - Phone:813-390-4340
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLISW81111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical