Healthcare Provider Details

I. General information

NPI: 1518556133
Provider Name (Legal Business Name): SHAMARLA TEAKE HUTCHINSON BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MS. SHAMARLA TEAKE PARKS-BULLARD

II. Dates (important events)

Enumeration Date: 01/18/2021
Last Update Date: 03/05/2025
Certification Date: 03/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1696 S MILITARY TRL STE C
WEST PALM BEACH FL
33415-5625
US

IV. Provider business mailing address

1008 GREEN PINE BLVD APT H1
WEST PALM BEACH FL
33409-7019
US

V. Phone/Fax

Practice location:
  • Phone: 561-284-6534
  • Fax:
Mailing address:
  • Phone: 754-367-1087
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number0-24-15117
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-25-79741
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: