Provider Demographics
NPI:1013446194
Name:LEYDON, SHAWNDRE MARIE (LMHC)
Entity type:Individual
Prefix:MRS
First Name:SHAWNDRE
Middle Name:MARIE
Last Name:LEYDON
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1680 SW BAYSHORE BLVD STE 233
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34984-3519
Mailing Address - Country:US
Mailing Address - Phone:772-353-2485
Mailing Address - Fax:772-264-6291
Practice Address - Street 1:1680 SW BAYSHORE BLVD
Practice Address - Street 2:SUITE 233
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34984-8774
Practice Address - Country:US
Practice Address - Phone:772-353-2485
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-12
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH20160261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)