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Individual

DR. SHAUNA M. EZELL

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PHD, LCSW

Contact information

Practice address
325TH MEDICAL GROUP, 340 MAGNOLIA CIRCLE, BLDG. 1465, TYNDALL AFB, FL 32403-5604
(850) 283-7511
Mailing address
340 MAGNOLIA CIR BLDG 1465, TYNDALL AFB, FL 32403-5604
(850) 283-7511

Taxonomy

Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
3097-57
WI
1041C0700X
Clinical Social Worker
7400-123
WI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
524139100
MN
Enumeration date
07/14/2006
Last updated
01/23/2026
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