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General NPI Number Information
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NPI Number | 1235949306
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Entity Type | Individual
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Provider Name | SHANIQUA ROBERTS
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Gender | Female
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Dates
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Enumeration Date | 01/10/2025
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Last Update Date | 01/10/2025
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Provider Practice Location Address
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Address Line | 5959 LAKE ELLENOR DR
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City | ORLANDO
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State | FL
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Zip | 32809-4633
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Country | US
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Telephone | 516-425-0933
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Fax |
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Provider Business Mailing Address
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Address Line | 517 SABAL LAKE DR APT 103
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City | LONGWOOD
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State | FL
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Zip | 32779-6279
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Country | US
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Telephone | 516-425-0933
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Fax |
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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 |
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License Number State |
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