Healthcare Provider Details

I. General information

NPI: 1205753126
Provider Name (Legal Business Name): SHAWNTEL GEMA SEBENY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2026
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1222 WINTER GARDEN VINELAND RD STE 112
WINTER GARDEN FL
34787-4449
US

IV. Provider business mailing address

14526 OCONEE LN
ORLANDO FL
32837-5842
US

V. Phone/Fax

Practice location:
  • Phone: 407-877-0029
  • Fax: 407-358-5207
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: