Provider Demographics
NPI:1073892840
Name:RADAY, SHANNON (MASTERS LEVEL)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:RADAY
Suffix:
Gender:
Credentials:MASTERS LEVEL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2433 S MYRTLE AVE
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32771-4448
Mailing Address - Country:US
Mailing Address - Phone:727-432-4367
Mailing Address - Fax:727-210-6945
Practice Address - Street 1:2433 S MYRTLE AVE
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32771-4448
Practice Address - Country:US
Practice Address - Phone:727-432-4367
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-11
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA8980101YM0800X
AZ22147101YM0800X
CO21908101YM0800X
VA0701014791101YM0800X
TN7006101YM0800X
FL12548101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty