Provider Demographics
NPI:1861761280
Name:SPAGNOLI, SHOKO NAKAMURA (MA)
Entity type:Individual
Prefix:
First Name:SHOKO
Middle Name:NAKAMURA
Last Name:SPAGNOLI
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3817 LOGGERHEAD LN
Mailing Address - Street 2:
Mailing Address - City:MIMS
Mailing Address - State:FL
Mailing Address - Zip Code:32754-3027
Mailing Address - Country:US
Mailing Address - Phone:407-556-4761
Mailing Address - Fax:
Practice Address - Street 1:3817 LOGGERHEAD LN
Practice Address - Street 2:
Practice Address - City:MIMS
Practice Address - State:FL
Practice Address - Zip Code:32754-3027
Practice Address - Country:US
Practice Address - Phone:407-556-4761
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-14
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 11557101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health