Healthcare Provider Details

I. General information

NPI: 1982056578
Provider Name (Legal Business Name): SHONA FLEMMING RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2016
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

475 S JOHN RODES BLVD
MELBOURNE FL
32904-1093
US

IV. Provider business mailing address

475 S JOHN RODES BLVD
MELBOURNE FL
32904-1093
US

V. Phone/Fax

Practice location:
  • Phone: 775-742-1912
  • Fax: 321-765-6434
Mailing address:
  • Phone: 775-742-1912
  • Fax: 321-765-6434

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1621254
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: