Healthcare Provider Details

I. General information

NPI: 1346841939
Provider Name (Legal Business Name): SHANNON SCHNEIDER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2020
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

875 MILITARY TRL STE 101B
JUPITER FL
33458-5700
US

IV. Provider business mailing address

875 MILITARY TRL STE 101B
JUPITER FL
33458-5700
US

V. Phone/Fax

Practice location:
  • Phone: 561-758-4540
  • Fax:
Mailing address:
  • Phone: 561-758-4540
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBACB625481
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: