Provider Demographics
NPI:1427344506
Name:ZIMMERMAN, SHAWN LEE (PHD)
Entity type:Individual
Prefix:DR
First Name:SHAWN
Middle Name:LEE
Last Name:ZIMMERMAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:549 N WYMORE RD
Mailing Address - Street 2:SUITE 209
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-4203
Mailing Address - Country:US
Mailing Address - Phone:407-580-6997
Mailing Address - Fax:
Practice Address - Street 1:549 N WYMORE RD
Practice Address - Street 2:SUITE 209
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-4203
Practice Address - Country:US
Practice Address - Phone:407-580-6997
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-27
Last Update Date:2012-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH9575101YM0800X
COPSY-2721103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103T00000XBehavioral Health & Social Service ProvidersPsychologist