Provider Demographics
NPI:1770008963
Name:YORK, SHANNON (PSYD)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:YORK
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8880 OLD KINGS RD S UNIT 71
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32257-5313
Mailing Address - Country:US
Mailing Address - Phone:904-469-6930
Mailing Address - Fax:
Practice Address - Street 1:8880 OLD KINGS RD S UNIT 71
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32257-5313
Practice Address - Country:US
Practice Address - Phone:904-469-6930
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-08
Last Update Date:2022-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLPY11411103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program