Healthcare Provider Details

I. General information

NPI: 1053242966
Provider Name (Legal Business Name): SHAYANA VENEREO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2026
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4015 CRESCENT PARK DR
RIVERVIEW FL
33578-3605
US

IV. Provider business mailing address

4231 HARTFORD LAKE DR
TAMPA FL
33619-6673
US

V. Phone/Fax

Practice location:
  • Phone: 813-492-8310
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-26-529465
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: