KAIYA SHANNON LCSW
NPI 1790917987
Social Worker - Clinical in Fort Myers, FL

Q: What is Kaiya Shannon's NPI number?

The NPI number for Kaiya Shannon is 1790917987. It was assigned to this individual provider in the NPPES registry on August 20, 2009.

Q: What is Kaiya Shannon's specialty?

The primary specialty registered for this NPI is Social Worker, specializing in Clinical, with taxonomy code 1041C0700X.

Q: When was this NPI record last updated?

The NPPES record for Kaiya Shannon was last updated on December 2, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since August 20, 2009PECOS Enrolled

15901 BASS RD STE 108, FORT MYERS, FL 33908(239) 343-6050(239) 343-6051 Get Directions Write a Review

NPPES record last updated: December 2, 2020. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: Dec 2, 2020, Jan 22, 2019 (2 updates tracked since 2019).

On this page

About Kaiya Shannon Lcsw NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

KAIYA SHANNON LCSW (NPI 1790917987) is an individual clinical provider in Fort Myers, Florida, licensed in Florida (SW 9520) and active in the NPI registry since August 2009. She is enrolled in Medicare PECOS and maintains a secondary practice location in Orlando.

NPPES Registry Identity

NPI1790917987

Entity TypeIndividualFemale

Primary Taxonomy1041C0700X

Provider Legal NameKAIYA SHANNONCredential: LCSW

Location Address15901 BASS RD STE 108Fort Myers, FL 33908-3838

Mailing AddressPo Box 2147Fort Myers, FL 33902-2147 · (239) 343-6050 · Fax (239) 343-6051

Phone(239) 343-6050

Fax(239) 343-6051

Sole ProprietorNo

Enumeration DateAugust 20, 2009

Last NPPES UpdateDecember 2, 20202 updates tracked since enumeration

NPPES CertifiedDecember 2, 2020

✔ NPI 1790917987 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySocial Worker · ClinicalBehavioral Health & Social Service Providers

Taxonomy Code1041C0700X

License✔ Licensed in FL · SW 9520

Definition

A social worker who holds a master's or doctoral degree in social work from an accredited school of social work in addition to at least two years of post-master's supervised experience in a clinical setting. The social worker must be licensed, certified, or registered at the clinical level in the jurisdiction of practice. A clinical social worker provides direct services, including interventions focused on interpersonal interactions, intrapsychic dynamics, and life management issues. Clinical social work services are based on bio-psychosocial perspectives. Services consist of assessment, diagnosis, treatment (including psychotherapy and counseling), client-centered advocacy, consultation, evaluation, and prevention of mental illness, emotional, or behavioral disturbances.

15901 BASS RD STE 108, Fort Myers, FL 33908

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Secondary Practice Location 1

Location 192 W Miller StOrlando, FL 32806-2032 · Phone (321) 841-7116 · Fax (321) 841-7116

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Superior HealthPlan, Ambetter Health, Cigna Healthcare and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Kaiya Shannon Lcsw is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignments

Medicare enrollment records show Kaiya Shannon reassigns Medicare billing to 2 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

Lee Health System Inc

0.2 mi

Internal Medicine

9981 S HEALTHPARK DR
Fort Myers, FL 33908

Reassigned Medicare billing, Florida enrollment
1,899 clinicians in this Medicare group

NPI 1942058557 (239) 424-1500

Lee Memorial Health System

0.2 mi

Internal Medicine

9981 S HEALTHPARK DR
Fort Myers, FL 33908

Reassigned Medicare billing, Florida enrollment
1,345 clinicians in this Medicare group

NPI 1992873319 (239) 424-1500

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 33908 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$0.00 typical visit price

range $58.56 – $179.05

Typical copayment $0.00 (range $14.64 – $44.76)

Most-billed visit code NA

Established Patient

$73.00 typical visit price

range $18.44 – $144.68

Typical copayment $18.25 (range $4.61 – $36.17)

Most-billed visit code 99213

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. DEEPA VADUTHALAKUZHY LUKA MD

Psychiatry & Neurology (Child & Adolescent Psychiatry)