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General NPI Number Information
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NPI Number | 1700794377
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Entity Type | Individual
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Provider Name | JENNELLA TRANEE BLACKSHEAR
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Gender | Female
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Dates
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Enumeration Date | 09/01/2026
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Last Update Date | 09/01/2026
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Provider Practice Location Address
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Address Line | 1771 E FLAMINGO RD STE 220A
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City | LAS VEGAS
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State | NV
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Zip | 89119-0850
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Country | US
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Telephone | 407-618-0493
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Fax | 855-864-1499
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Provider Business Mailing Address
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Address Line | 1689 AURORA RIDGE DR
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City | ZELLWOOD
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State | FL
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Zip | 32798-5424
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Country | US
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Telephone | 689-205-7919
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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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