Ezell, Shauna M.

Ezell, Shauna M. is an individual health care provider with primary practice located at 325Th Medical Group 340 Magnolia Circle, Bldg. 1465, Tyndall Afb FL 32403-5604. She recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as her primary health care specialty. Ezell, Shauna M. can be contacted via phone (850) 283-7511.

Contact Information

Primary practice address
325Th Medical Group 340 Magnolia Circle, Bldg. 1465 Tyndall Afb FL 32403-5604
Phone: (850) 283-7511
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Clinical 1041C0700X 7400-123 Wisconsin
Behavioral Health & Social Service Providers / Clinical 103TC0700X 3097-57 Wisconsin

Profile Details

NPI number 1780600858
LBN Legal business name Ezell, Shauna M.
Credentials PHD, LCSW
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 14th, 2006
Last updated Apr 21st, 2022 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1780600858 NPPES
Minnesota MEDICAID 524139100

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