Provider Demographics
NPI:1790887982
Name:VIA, SHELENE ANN
Entity Type:Individual
Prefix:MS
First Name:SHELENE
Middle Name:ANN
Last Name:VIA
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 1:700 W 23RD ST STE 100
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-3932
Mailing Address - Country:US
Mailing Address - Phone:850-747-5411
Mailing Address - Fax:850-747-5583
Practice Address - Street 1:700 W 23RD ST STE 100
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-3932
Practice Address - Country:US
Practice Address - Phone:850-747-5411
Practice Address - Fax:850-747-5583
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker