Sha'leda Mirra, is a medicare enrolled "Social Worker - Clinical" provider in Lake City, Florida. Her current practice location is
922 Sw Baya Dr, Lake City, Florida. You can reach out to her office (for appointments etc.) via phone at
(386) 697-8115.
Sha'leda Mirra is licensed to practice in Florida (license number SW11702) and she also participates in the medicare program. She does not accept medicare assignments directly but she may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. Her NPI Number is 1780015214.
Healthcare Provider's Profile
| Full Name | Sha'leda Mirra |
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| Gender | Female |
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| Speciality | Social Worker - Clinical |
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| Location | 922 Sw Baya Dr, Lake City, Florida |
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| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
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NPI Data:
- NPI Number: 1780015214
- Provider Enumeration Date: 12/10/2013
- Last Update Date: 12/10/2013
Medicare PECOS Information:
- PECOS PAC ID: 4385984723
- Enrollment ID: I20190320003134
Medical Identifiers
Medical identifiers for Sha'leda Mirra such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1780015214 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | 5724 (Florida) | Secondary |
| 1041C0700X | Social Worker - Clinical | SW11702 (Florida) | Primary |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Sha'leda Mirra allows following entities to bill medicare on her behalf.
| Entity Name | Refresh Canopy Cove, Inc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1730661752
PECOS PAC ID: 3779822119
Enrollment ID: O20190304000354 |
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| Entity Name | Vitae Health Of Florida Llc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1013562024
PECOS PAC ID: 6204166762
Enrollment ID: O20190925003271 |
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| Entity Name | Optum Behavioral Care Of North Carolina, P.c. |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1033984448
PECOS PAC ID: 5092120030
Enrollment ID: O20240401000110 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Sha'leda Mirra is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Sha'leda Mirra,
793 Sw Nautilus Rd,
Lake City, FL 32024-1335
Ph: (386) 984-6618 | Sha'leda Mirra,
922 Sw Baya Dr,
Lake City, FL 32025-4209
Ph: (386) 697-8115 |
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