Provider Demographics
NPI:1982125902
Name:SHUTT, ELIZABETH ANN (PHD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:ANN
Last Name:SHUTT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:ELIZABETH
Other - Middle Name:ANN
Other - Last Name:HAYS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:5401 S KIRKMAN RD STE 730
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-7911
Mailing Address - Country:US
Mailing Address - Phone:407-982-8516
Mailing Address - Fax:
Practice Address - Street 1:5401 S KIRKMAN RD STE 730
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-7911
Practice Address - Country:US
Practice Address - Phone:407-704-7608
Practice Address - Fax:407-982-8516
Is Sole Proprietor?:No
Enumeration Date:2017-06-29
Last Update Date:2019-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY10388103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist