Provider Demographics
NPI:1720389406
Name:SPANN, SHAKEYIA REAUCHEAN (MBA, LCSW)
Entity type:Individual
Prefix:MS
First Name:SHAKEYIA
Middle Name:REAUCHEAN
Last Name:SPANN
Suffix:
Gender:F
Credentials:MBA, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15757 PINES BLVD # 197
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33027-1207
Mailing Address - Country:US
Mailing Address - Phone:954-282-9443
Mailing Address - Fax:
Practice Address - Street 1:1100 W MCNAB RD STE 104
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33309-1116
Practice Address - Country:US
Practice Address - Phone:954-282-9443
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-10
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0079591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6009198Medicaid
FL120897900Medicaid