Provider Demographics
NPI:1730467325
Name:FLORVELLA, SHANA CAMILLE KIRBY (MD)
Entity Type:Individual
Prefix:
First Name:SHANA
Middle Name:CAMILLE KIRBY
Last Name:FLORVELLA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SHANA
Other - Middle Name:CAMILLE
Other - Last Name:KIRBY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 917770
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32891-7770
Mailing Address - Country:US
Mailing Address - Phone:813-974-2201
Mailing Address - Fax:
Practice Address - Street 1:3515 E FLETCHER AVE # MDC14
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-4702
Practice Address - Country:US
Practice Address - Phone:813-974-8900
Practice Address - Fax:813-974-1131
Is Sole Proprietor?:No
Enumeration Date:2011-07-29
Last Update Date:2018-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010989522084P0800X
FLME 1193092084P0804X
FLME1193092084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLX345LOtherBLUE CROSS BLUE SHIELD FLORIDA
FL017931400Medicaid
FL017931400Medicaid