Provider Demographics
NPI:1730609959
Name:SIRACUSA, SHANNON (LMHC)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:SIRACUSA
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:
Other - Last Name:SIRACUSA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMHC
Mailing Address - Street 1:401 NW 43RD CT APT 2
Mailing Address - Street 2:
Mailing Address - City:OAKLAND PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33309-4867
Mailing Address - Country:US
Mailing Address - Phone:763-957-9399
Mailing Address - Fax:
Practice Address - Street 1:401 NW 43RD CT APT 2
Practice Address - Street 2:
Practice Address - City:OAKLAND PARK
Practice Address - State:FL
Practice Address - Zip Code:33309-4867
Practice Address - Country:US
Practice Address - Phone:763-957-9399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-20
Last Update Date:2025-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL22831OtherLMHC
MA1154302586Medicaid
MA11441OtherLMHC