Provider Demographics
NPI:1932846706
Name:STOTTS, SHAWNA JAMIE (PSYD, LCSW)
Entity Type:Individual
Prefix:
First Name:SHAWNA
Middle Name:JAMIE
Last Name:STOTTS
Suffix:
Gender:F
Credentials:PSYD, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1521 ALTON RD UNIT 310
Mailing Address - Street 2:
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33139-3301
Mailing Address - Country:US
Mailing Address - Phone:305-978-6669
Mailing Address - Fax:
Practice Address - Street 1:96 SW ALLAPATTAH RD
Practice Address - Street 2:
Practice Address - City:INDIANTOWN
Practice Address - State:FL
Practice Address - Zip Code:34956-4307
Practice Address - Country:US
Practice Address - Phone:772-597-9400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-13
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY34972103T00000X
FLPY11329103T00000X, 103TF0200X
FLSW149341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical