Provider Demographics
NPI:1922235290
Name:ALLEN, SHANNA RHEA PRESTON (MA CCC)
Entity Type:Individual
Prefix:MRS
First Name:SHANNA
Middle Name:RHEA PRESTON
Last Name:ALLEN
Suffix:
Gender:F
Credentials:MA CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35015 MEADOW REACH DR
Mailing Address - Street 2:
Mailing Address - City:ZEPHYRHILLS
Mailing Address - State:FL
Mailing Address - Zip Code:33541-1964
Mailing Address - Country:US
Mailing Address - Phone:813-415-9653
Mailing Address - Fax:
Practice Address - Street 1:35015 MEADOW REACH DR
Practice Address - Street 2:
Practice Address - City:ZEPHYRHILLS
Practice Address - State:FL
Practice Address - Zip Code:33541
Practice Address - Country:US
Practice Address - Phone:813-415-9653
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-15
Last Update Date:2018-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
222Q00000X
KY3800235Z00000X
KY09-049235Z00000X
FLSA12638235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL014374500Medicaid
FL010400600Medicaid