Provider Demographics
NPI:1699586933
Name:SHAIRS, DEREK JOSEPH (RMHCI)
Entity type:Individual
Prefix:MR
First Name:DEREK
Middle Name:JOSEPH
Last Name:SHAIRS
Suffix:
Gender:M
Credentials:RMHCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13936 SPOONBILL ST N
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32224-1387
Mailing Address - Country:US
Mailing Address - Phone:978-888-7392
Mailing Address - Fax:
Practice Address - Street 1:6817 SOUTHPOINT PKWY STE 2503
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-8200
Practice Address - Country:US
Practice Address - Phone:904-326-0246
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-16
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH27054101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health