Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Shannon Fowler, PHD, LP

Individual provider Clinical Psychologist · NPI 1619378650

Shannon Fowler, PHD, LP is a Clinical Psychologist in Longwood, Florida. Qualified in 2014, 12 years ago. Practices with Mental Health Specialty Group PA, a 679-clinician group and accepts Medicare assignment. Licensed in Florida, Michigan and Virginia.

Years since qualifying
12
Licensed in
FL, MI, VA
In the registry since
2014
Specialties on file
3
What do these letters mean?
PHD — Doctor of Philosophy
A research doctorate. In healthcare it usually sits alongside a clinical licence.

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Practice location Address checks out

741 Riverbend Blvd
Longwood, FL 32779-2347
Phone: (734) 474-0530
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Clinical Psychologist (primary) Taxonomy 103TC0700X · Licence 6301016051 (MI)
Clinical Psychologist Taxonomy 103TC0700X · Licence 0810005172 (VA)
Clinical Psychologist Taxonomy 103TC0700X · Licence PY10662 (FL)

Record details

NPI number1619378650
Entity typeIndividual (Type 1)
GenderFemale
Credentials PHD , LP
Sole proprietorNo
NPI enumeratedSeptember 9, 2014
Last updated in NPPESDecember 9, 2021
Certification dateDecember 9, 2021

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyCLINICAL PSYCHOLOGIST
Medical schoolOTHER
Graduated 2014 (12 years in practice)
Group practice Mental Health Specialty Group Pa — 679 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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