Provider Demographics
NPI:1962609263
Name:CARTER, SHANNON ELIZABETH (PHD)
Entity type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:ELIZABETH
Last Name:CARTER
Suffix:
Gender:F
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:PO BOX 947785
Mailing Address - Street 2:
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32794-7785
Mailing Address - Country:US
Mailing Address - Phone:407-212-0910
Mailing Address - Fax:
Practice Address - Street 1:235 S MAITLAND AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-5677
Practice Address - Country:US
Practice Address - Phone:407-628-5354
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-29
Last Update Date:2008-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY7823103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical