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General NPI Number Information
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NPI Number | 1457027021
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Entity Type | Individual
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Provider Name | BRANDI NIKKOLE SHEPHERD
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Gender | Female
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Dates
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Enumeration Date | 08/23/2021
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Last Update Date | 12/24/2024
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Provider Practice Location Address
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Address Line | 2574 COMMERCE PKWY
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City | NORTH PORT
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State | FL
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Zip | 34289-9334
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Country | US
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Telephone | 813-498-1093
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Fax |
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Provider Business Mailing Address
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Address Line | 6510 MECHLER ST
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City | ENGLEWOOD
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State | FL
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Zip | 34224-8830
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Country | US
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Telephone | 843-713-9648
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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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