Sha'Leda Mirra

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

SW11702 Issued in FL

Practice address

922 SW Baya Dr
Lake City, FL 32025-4209

Phone

(386) 697-8115

NPI assigned

Dec 10, 2013

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Social Worker

Education

Other, 2011

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Optum Behavioral Care of North Carolina PCGroup PAC ID 5092120030, 175 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Optum Behavioral Care of North Carolina, PC

  • Counseling Psychologist
  • Sarasota, FL
  • NPI 1033984448
  Medicare reassignment Care Compare group NPD
• Vitae Health Medical Florida PLLC

  • Internal Medicine Physician
  • Rockledge, FL
  • NPI 1013562024

  Clinical

  Medicare reassignment NPD
• Grow Healthcare Group PA

  • Mental Health Counselor
  • Miami, FL
  • NPI 1245845932
  Medicare reassignment
• Optum Behavioral Care of North Carolina, P.C.

  • Clinical Social Worker
  • Gulfport, MS
  • NPI 1861371718
  NPD
• Senior Living Behavioral Health LCSW PLLC

  • Clinical Social Worker
  • New York, NY
  • NPI 1083150056
  NPD (past)

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

{
    "created_epoch": "1386633600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1386633600000",
    "number": "1780015214",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "793 SW NAUTILUS RD",
            "city": "LAKE CITY",
            "state": "FL",
            "postal_code": "320241335",
            "telephone_number": "386-984-6618"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "922 SW BAYA DR",
            "city": "LAKE CITY",
            "state": "FL",
            "postal_code": "320254209",
            "telephone_number": "386-697-8115"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MIRRA",
        "first_name": "SHA'LEDA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-12-10",
        "last_updated": "2013-12-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "FL",
            "license": "5724",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "FL",
            "license": "SW11702",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kayleigh Christine Miller, LMT
• Pamula Nicole Miller
• Adrian Mincey
• Mindful Impact Counseling and Coaching
• Jesenia Minniefield, MSW, LCSW
• Mission Medical Family Practice Inc.
• Anita E Mitchell, LMSW
• Maria Alana Mitchell, LPN
• Michayla Marie Mitchell
• Tracie Ledora Mitchem-Green, F.N.P

• Clinical Social Worker in Lake City, FL
• Providers in Lake City, FL by specialty
• Clinical Social Worker in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.