Provider Demographics
NPI:1942444161
Name:MCCOWN, SHAWNTISHA
Entity Type:Individual
Prefix:
First Name:SHAWNTISHA
Middle Name:
Last Name:MCCOWN
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 1:27018 SW 135TH AVE
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33032-7761
Mailing Address - Country:US
Mailing Address - Phone:786-329-9819
Mailing Address - Fax:
Practice Address - Street 1:27018 SW 135TH AVE
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33032-7761
Practice Address - Country:US
Practice Address - Phone:786-329-9819
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-01
Last Update Date:2009-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst