MEDICARE: SEAN MCCOY BCABA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	0-10-3910

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013446848
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SEAN MCCOY BCABA

Provider Business Mailing Address
First Line	:	7663 CR 247
Second Line	:
City	:	LAKE PANASOFFKEE
State	:	FL
Zip	:	33538-3047
Country	:	US
Telephone Number	:	813-957-8327
Fax Number	:

Provider Business Practice Location Address
First Line	:	7663 CR 247
Second Line	:
City	:	LAKE PANASOFFKEE
State	:	FL
Zip	:	33538-3047
Country	:	US
Telephone Number	:	813-957-8327
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/06/2017
Last Update Date	:	07/21/2022

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Directions to “ SEAN MCCOY BCABA” Practice Location

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