Provider Demographics
NPI:1790942233
Name:MAINE, SHAWNDRA ERICA
Entity Type:Individual
Prefix:MRS
First Name:SHAWNDRA
Middle Name:ERICA
Last Name:MAINE
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 1:7264 W OAKLAND PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:LAUDERHILL
Mailing Address - State:FL
Mailing Address - Zip Code:33313-1041
Mailing Address - Country:US
Mailing Address - Phone:954-703-1165
Mailing Address - Fax:954-900-4645
Practice Address - Street 1:7264 W OAKLAND PARK BLVD
Practice Address - Street 2:
Practice Address - City:LAUDERHILL
Practice Address - State:FL
Practice Address - Zip Code:33313-1041
Practice Address - Country:US
Practice Address - Phone:954-703-1165
Practice Address - Fax:954-900-4645
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-21
Last Update Date:2021-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No251S00000XAgenciesCommunity/Behavioral Health