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General NPI Number Information
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NPI Number | 1528854049
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Entity Type | Individual
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Provider Name | SHAVANNA DOUGLAS
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Gender | Female
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Dates
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Enumeration Date | 04/21/2025
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Last Update Date | 04/21/2025
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Provider Practice Location Address
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Address Line | 777 BRICKELL AVE STE 500
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City | MIAMI
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State | FL
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Zip | 33131-2803
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Country | US
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Telephone | 305-330-4660
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Fax | 786-217-1376
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Provider Business Mailing Address
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Address Line | 11233 SW 243RD TER
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City | HOMESTEAD
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State | FL
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Zip | 33032-7124
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Country | US
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Telephone | 786-397-2761
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Fax | 786-217-1376
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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 | 106E00000X
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Taxonomy Name | Assistant Behavior Analyst
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License Number | 0-25-16005
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License Number State | FL
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