Shaana D Wilson

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Practice address

1307 Apollo Beach Blvd S Unit 101
Apollo Beach, FL 33572-3092

Phone

(813) 410-7025

NPI assigned

Sep 10, 2012

Last updated

May 20, 2025By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Locations

Networks

• Freedom Health HMO Network

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Revolutionary Change Counseling LLC

  • Mental Health Counselor
  • Apollo Beach, FL
  • NPI 1811417645
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1347235200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1747699200000",
    "number": "1467701136",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1307 APOLLO BEACH BLVD S UNIT 101",
            "city": "APOLLO BEACH",
            "state": "FL",
            "postal_code": "335723092",
            "telephone_number": "813-410-7025"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1307 APOLLO BEACH BLVD S UNIT 101",
            "city": "APOLLO BEACH",
            "state": "FL",
            "postal_code": "335723092",
            "telephone_number": "813-410-7025"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "SHAANA",
        "middle_name": "D",
        "name_prefix": "Ms.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-09-10",
        "last_updated": "2025-05-20",
        "certification_date": "2025-05-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP1600X",
            "taxonomy_group": "",
            "desc": "Counselor, Pastoral",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "120613000",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "010658700",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Martin Cortez Wesley, PH.D., LPCC-S. LMHC
• Randall P Weyrich, MD
• Kevin John Whitworth, M.D.
• Stephanie Williams
• Tom Martin Williams, DMD
• Andrew Win
• William Withers
• Jonathan Woolverton, APRN
• Wound Logix Inc
• Jin Yang, OD, PHD

• Mental Health Counselor in Apollo Beach, FL
• Providers in Apollo Beach, FL by specialty
• Mental Health Counselor in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.