Healthcare Provider Details

I. General information

NPI: 1427975564
Provider Name (Legal Business Name): SHANNON LORRAINE DIXON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2026
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3410 TALLEYRAND AVE
JACKSONVILLE FL
32206-2650
US

IV. Provider business mailing address

3410 TALLEYRAND AVE
JACKSONVILLE FL
32206-2650
US

V. Phone/Fax

Practice location:
  • Phone: 929-323-6430
  • Fax:
Mailing address:
  • Phone: 929-323-6430
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-25-474804
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: