Active NPI
Kerryanne Shea, LMFT
- Family Psychologist
- Eustis, FL
National Provider Identifier
1487921730
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Psychologist
- License
- MT 1876
- Practice address
- 201 E Magnolia Ave
Eustis, FL 32726-3583 - Phone
- (352) 315-7100
- Fax
- (352) 360-6582
- NPI assigned
- Nov 30, 2011
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Psychologist | 103TF0000X | MT 1876 | FL | Primary |
Addresses
Primary practice location
201 E Magnolia Ave
Eustis, FL 32726-3583
Mailing address
1008 Delaney Park Dr
Orlando, FL 32806-1326
Phone (352) 315-7100
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MT 1876 | FL | MD | Family Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lifestream Behavioral Center Inc | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Primary Care Clinic/Center
- Leesburg, FL
- NPI 1659613776
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1322611200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1322611200000",
"number": "1487921730",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1008 DELANEY PARK DR",
"city": "ORLANDO",
"state": "FL",
"postal_code": "328061326",
"telephone_number": "352-315-7100",
"fax_number": "352-360-6582"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "201 E MAGNOLIA AVE",
"city": "EUSTIS",
"state": "FL",
"postal_code": "327263583",
"telephone_number": "352-315-7100",
"fax_number": "352-360-6582"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHEA",
"first_name": "KERRYANNE",
"credential": "LMFT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-11-30",
"last_updated": "2011-11-30",
"status": "A"
},
"taxonomies": [
{
"code": "103TF0000X",
"taxonomy_group": "",
"desc": "Psychologist, Family",
"state": "FL",
"license": "MT 1876",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Eustis, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.