MEDICARE: SHEREISE ROLLINS 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
1	103K00000X	Behavior Analyst		GA
2	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1649711599
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHEREISE ROLLINS BCBA

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	:	407-908-7356
Fax Number	:	407-588-6294

Provider Business Practice Location Address
First Line	:	5461 HILLANDALE DR STE 100
Second Line	:
City	:	LITHONIA
State	:	GA
Zip	:	30058-4842
Country	:	US
Telephone Number	:	866-610-0580
Fax Number	:

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

Provider Enumeration Date	:	03/12/2017
Last Update Date	:	08/03/2020

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Directions to “ SHEREISE ROLLINS BCBA” Practice Location

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