Healthcare Provider Details

I. General information

NPI: 1063024040
Provider Name (Legal Business Name): SHAYLA C BAXTER RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2020
Last Update Date: 08/20/2020
Certification Date: 08/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18288 N US HWY 41
LUTZ FL
33549-4400
US

IV. Provider business mailing address

18288 N US HWY 41
LUTZ FL
33549-4400
US

V. Phone/Fax

Practice location:
  • Phone: 813-527-9638
  • Fax: 813-867-7288
Mailing address:
  • Phone: 813-527-9638
  • Fax: 813-867-7288

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-20-131544
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: