Provider Demographics
NPI:1215522545
Name:SHANNON, DAPHNE SAINVIL (LCSW)
Entity type:Individual
Prefix:MRS
First Name:DAPHNE
Middle Name:SAINVIL
Last Name:SHANNON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4800 DEERWOOD CAMPUS PKWY
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32246-8317
Mailing Address - Country:US
Mailing Address - Phone:954-477-9442
Mailing Address - Fax:
Practice Address - Street 1:4800 DEERWOOD CAMPUS PKWY
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32246-8317
Practice Address - Country:US
Practice Address - Phone:954-477-9442
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-08
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
FLSW164521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty