Provider Demographics
NPI:1982619540
Name:HEATON, SHELLEY CHRISTINE (PHD)
Entity type:Individual
Prefix:DR
First Name:SHELLEY
Middle Name:CHRISTINE
Last Name:HEATON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:SHELLEY
Other - Middle Name:CHRISTINE
Other - Last Name:HEATON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 918025
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32891-8025
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1600 SW ARCHER RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-3003
Practice Address - Country:US
Practice Address - Phone:352-265-0294
Practice Address - Fax:352-265-0296
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2008-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY7145103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL211932300Medicaid