Provider Demographics
NPI:1770056384
Name:SHANE LYNN ( S&D BEHAVIORAL HEALTH)
Entity type:Organization
Organization Name:SHANE LYNN ( S&D BEHAVIORAL HEALTH)
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIC NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:SHANE
Authorized Official - Middle Name:
Authorized Official - Last Name:LYNN
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:727-641-4435
Mailing Address - Street 1:2710 ALTERNATE 19 N 403B
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34683-3203
Mailing Address - Country:US
Mailing Address - Phone:727-275-3601
Mailing Address - Fax:
Practice Address - Street 1:2710 ALTERNATE 19 N 403B
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34683-3203
Practice Address - Country:US
Practice Address - Phone:727-275-3601
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-07
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty