Provider Demographics
NPI:1942601554
Name:SOPKO, SHANA (MA)
Entity Type:Individual
Prefix:
First Name:SHANA
Middle Name:
Last Name:SOPKO
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1727 SWEETWATER WEST CIR
Mailing Address - Street 2:
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32712-2481
Mailing Address - Country:US
Mailing Address - Phone:407-748-7885
Mailing Address - Fax:
Practice Address - Street 1:1727 SWEETWATER WEST CIR
Practice Address - Street 2:
Practice Address - City:APOPKA
Practice Address - State:FL
Practice Address - Zip Code:32712-2481
Practice Address - Country:US
Practice Address - Phone:407-748-7885
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-15
Last Update Date:2014-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health