Healthcare Provider Details

I. General information

NPI: 1154237907
Provider Name (Legal Business Name): BAILEY RYANN SHANAHAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2026
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11011 SHERIDAN ST STE 210
HOLLYWOOD FL
33026-1531
US

IV. Provider business mailing address

3510 NW 121ST AVE
SUNRISE FL
33323-3302
US

V. Phone/Fax

Practice location:
  • Phone: 954-552-6668
  • Fax: 954-206-5584
Mailing address:
  • Phone: 954-931-1345
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: