Provider Demographics
NPI:1982012563
Name:WELLS, SHEDENA (EDS)
Entity Type:Individual
Prefix:MS
First Name:SHEDENA
Middle Name:
Last Name:WELLS
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1472 CASA RD
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32940-6941
Mailing Address - Country:US
Mailing Address - Phone:941-320-3232
Mailing Address - Fax:
Practice Address - Street 1:1472 CASA RD
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940-6941
Practice Address - Country:US
Practice Address - Phone:941-320-3232
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-28
Last Update Date:2014-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1085627101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool