Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | PY 9086 | FL |
Y | 103T00000X | Psychologist | PY 9086 | FL |
N | 103TS0200X | School Psychologist | SS 1235 | FL |
NPI | 1053852954 |
---|---|
Provider Name | Dr. Shannon Bennett |
First Address | Tallahassee, FL 32306-1603 |
Second Address | Tallahassee, FL 32306-1603 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/03/2017 |
Last Update Date | 13/03/2017 |