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NPI Code Detail

MEDICARE: SHAPING EXPECTATIONS THERAPY

MEDICARE: SHAPING EXPECTATIONS THERAPY
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 AnalystFL

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 : 1407363641
Entity Type Code : Organization
Provider Name (Legal Business Name) : SHAPING EXPECTATIONS THERAPY
Provider Business Mailing Address
First Line : 4940 NORTHDALE BLVD
Second Line :
City : TAMPA
State : FL
Zip : 33624-1075
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4940 NORTHDALE BLVD
Second Line :
City : TAMPA
State : FL
Zip : 33624-1075
Country : US
Telephone Number : 813-485-8444
Fax Number :
Authorized Official
Title or Position : MANAGING MEMBER
Name : ALIVIA CAMPBELL
Credential :
Telephone Number : 813-485-8444
Provider Enumeration Date : 01/09/2018
Last Update Date : 02/08/2023

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33624-1075
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1083228407 — JESSIE RENAUD
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Directions to “SHAPING EXPECTATIONS THERAPY ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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