Provider Demographics
NPI:1043663982
Name:CARAMIELLO, SHANNON
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:CARAMIELLO
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2611 KEYSTONE RD STE B3
Mailing Address - Street 2:
Mailing Address - City:TARPON SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34688-7403
Mailing Address - Country:US
Mailing Address - Phone:727-275-0282
Mailing Address - Fax:727-205-4466
Practice Address - Street 1:2611 KEYSTONE RD STE B3
Practice Address - Street 2:
Practice Address - City:TARPON SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34688-7403
Practice Address - Country:US
Practice Address - Phone:727-275-0282
Practice Address - Fax:727-205-4466
Is Sole Proprietor?:No
Enumeration Date:2016-07-15
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL10177103TC0700X, 103G00000X, 103TA0700X
FLPY10177103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & Aging