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NPI Code Detail

MEDICARE: ASIA LEANNE SHEPHERD

MEDICARE: ASIA LEANNE SHEPHERD
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
1106S00000XBehavior Technician

Other Identifiers

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

General Provider Information

NPI Number : 1407326317
Entity Type Code : Individual
Provider Name (Legal Business Name) : ASIA LEANNE SHEPHERD
Provider Business Mailing Address
First Line : 300 INTERNATIONAL PKWY STE 200
Second Line :
City : LAKE MARY
State : FL
Zip : 32746-5028
Country : US
Telephone Number : 866-610-0580
Fax Number :
Provider Business Practice Location Address
First Line : 12725 RACE TRACK RD BLDG 5
Second Line :
City : WESTCHASE
State : FL
Zip : 33626-1314
Country : US
Telephone Number : 866-610-0580
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/04/2018
Last Update Date : 08/16/2019

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Directions to “ ASIA LEANNE SHEPHERD ” Practice Location

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