Active NPI
Shauna M. Ezell, PHD, LCSW
- Clinical Psychologist
- Tyndall Afb, FL
National Provider Identifier
1780600858
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 3097-57
- Practice address
- 325TH Medical Group
340 Magnolia Circle, BLDG. 1465
Tyndall Afb, FL 32403-5604 - Phone
- (850) 283-7511
- NPI assigned
- Jul 14, 2006
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 7400-123 | WI | |
| Clinical Psychologist | 103TC0700X | 3097-57 | WI | Primary |
Addresses
Primary practice location
325TH Medical Group
340 Magnolia Circle, BLDG. 1465
Tyndall Afb, FL 32403-5604
Mailing address
340 Magnolia Cir BLDG 1465
Tyndall Afb, FL 32403-5604
Phone (850) 283-7511
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 524139100 | Medicaid | MN |
Other names 1
- Ms. Shauna M. Johnson
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)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3097-57 | WI | MD | Clinical Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lutheran Services in Iowa, 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.
-
- Social Worker
- Des Moines, IA
- NPI 1831278142
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152835200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1769126400000",
"number": "1780600858",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "340 MAGNOLIA CIR BLDG 1465",
"city": "TYNDALL AFB",
"state": "FL",
"postal_code": "324035604",
"telephone_number": "850-283-7511"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "325TH MEDICAL GROUP",
"address_2": "340 MAGNOLIA CIRCLE, BLDG. 1465",
"city": "TYNDALL AFB",
"state": "FL",
"postal_code": "324035604",
"telephone_number": "850-283-7511"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EZELL",
"first_name": "SHAUNA",
"middle_name": "M.",
"name_prefix": "Dr.",
"credential": "PHD, LCSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-07-14",
"last_updated": "2026-01-23",
"certification_date": "2026-01-23",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "WI",
"license": "7400-123",
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "WI",
"license": "3097-57",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "524139100",
"state": "MN"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "SHAUNA",
"last_name": "JOHNSON",
"middle_name": "M.",
"prefix": "MS.",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Tyndall Afb, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.