Provider Demographics
NPI:1720778764
Name:GRABIAK, SHELLY NICHOLE (MSW, RCSWI)
Entity Type:Individual
Prefix:
First Name:SHELLY
Middle Name:NICHOLE
Last Name:GRABIAK
Suffix:
Gender:F
Credentials:MSW, RCSWI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1910 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34748-4880
Mailing Address - Country:US
Mailing Address - Phone:305-879-8662
Mailing Address - Fax:
Practice Address - Street 1:1910 HIGH ST
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-4880
Practice Address - Country:US
Practice Address - Phone:305-879-8662
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-12
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL166891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical