Provider Demographics
NPI:1245957711
Name:GAUDETTE, SHELBY BEATRICE MOONEY (MSW)
Entity type:Individual
Prefix:
First Name:SHELBY
Middle Name:BEATRICE MOONEY
Last Name:GAUDETTE
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:219 COOK ST
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-5216
Mailing Address - Country:US
Mailing Address - Phone:813-480-8482
Mailing Address - Fax:
Practice Address - Street 1:219 COOK ST
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-5216
Practice Address - Country:US
Practice Address - Phone:813-480-8482
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-25
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLISW179671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical