Provider Demographics
NPI:1205250495
Name:SELLERS, SHAWNNA ALEXANDRA (LMT)
Entity type:Individual
Prefix:
First Name:SHAWNNA
Middle Name:ALEXANDRA
Last Name:SELLERS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:433 CENTRAL AVE STE 211
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-3854
Mailing Address - Country:US
Mailing Address - Phone:727-430-0310
Mailing Address - Fax:
Practice Address - Street 1:433 CENTRAL AVE
Practice Address - Street 2:SUITE 211
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-3853
Practice Address - Country:US
Practice Address - Phone:727-430-0310
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-10
Last Update Date:2014-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA74061174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator