MEDICARE: SHADIANNA SINGH VINSON

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	106E00000X	Assistant Behavior Analyst	0010314	FL

General Provider Information

NPI Number	:	1134013295
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHADIANNA SINGH VINSON

Provider Business Mailing Address
First Line	:	2317 BLANDING BLVD STE 102
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32210-4167
Country	:	US
Telephone Number	:	904-200-7979
Fax Number	:	904-200-7979

Provider Business Practice Location Address
First Line	:	2317 BLANDING BLVD STE 102
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32210-4167
Country	:	US
Telephone Number	:	904-200-7979
Fax Number	:	904-200-7979

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

Provider Enumeration Date	:	06/04/2025
Last Update Date	:	03/17/2026

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Directions to “ SHADIANNA SINGH VINSON ” Practice Location

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