Provider Demographics
NPI:1316731664
Name:JAMES, SHANIAH
Entity type:Individual
Prefix:
First Name:SHANIAH
Middle Name:
Last Name:JAMES
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:745 ORIENTA AVE STE 1011
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32701-5675
Mailing Address - Country:US
Mailing Address - Phone:877-823-4283
Mailing Address - Fax:352-332-8589
Practice Address - Street 1:2102 SW 20TH PL STE 302
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-0858
Practice Address - Country:US
Practice Address - Phone:877-823-4283
Practice Address - Fax:352-332-8589
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-09
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty