MEDICARE: SHANIK D PRENDES

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	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1356852750
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANIK D PRENDES

Provider Business Mailing Address
First Line	:	10775 NW 50TH ST APT 208
Second Line	:
City	:	DORAL
State	:	FL
Zip	:	33178-3967
Country	:	US
Telephone Number	:	786-774-2454
Fax Number	:

Provider Business Practice Location Address
First Line	:	500 E LAS OLAS BLVD APT 3908
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33301-2589
Country	:	US
Telephone Number	:	786-774-2032
Fax Number	:

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

Provider Enumeration Date	:	10/12/2017
Last Update Date	:	11/30/2022

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Directions to “ SHANIK D PRENDES ” Practice Location

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