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General NPI Number Information
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NPI Number | 1174475875
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Entity Type | Individual
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Provider Name | SHANTAVIA BERRY RBT
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Gender | Female
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Dates
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Enumeration Date | 02/13/2026
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Last Update Date | 02/13/2026
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Provider Practice Location Address
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Address Line | 1075 OAKLEAF PLANTATION PKWY STE 101
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City | ORANGE PARK
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State | FL
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Zip | 32065-3626
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Country | US
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Telephone | 904-945-6205
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Fax | 888-498-7244
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Provider Business Mailing Address
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Address Line | 3230 CALLIE LN
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City | GREEN COVE SPRINGS
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State | FL
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Zip | 32043-9591
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Country | US
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Telephone | 904-945-6205
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Fax | 888-498-7244
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | RBT-26-514545
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License Number State |
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