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NPI Code Detail

MEDICARE: MRS. SHANNON NICHOLE MARTINEZ BCBA

MEDICARE: MRS. SHANNON NICHOLE MARTINEZ BCBA
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
1103K00000XBehavior Analyst

General Provider Information

NPI Number : 1215376611
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. SHANNON NICHOLE MARTINEZ BCBA
Provider Business Mailing Address
First Line : 7108 S KANNER HWY
Second Line :
City : STUART
State : FL
Zip : 34997-7462
Country : US
Telephone Number : 855-832-6727
Fax Number : 772-675-9100
Provider Business Practice Location Address
First Line : 1708 AUGUSTA ST STE C-226
Second Line :
City : GREENVILLE
State : SC
Zip : 29605-6513
Country : US
Telephone Number : 855-832-6727
Fax Number : 772-675-9100
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/18/2013
Last Update Date : 01/06/2022

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