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NPI Code Detail

MEDICARE: MONTANA SHADWICK BCBA

MEDICARE: MONTANA SHADWICK BCBA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103K00000XBehavior Analyst1-15-20844FL
2103K00000XBehavior Analyst11520844FL

General Provider Information

NPI Number : 1053778688
Entity Type Code : Individual
Provider Name (Legal Business Name) : MONTANA SHADWICK BCBA
Provider Business Mailing Address
First Line : 315 EDGE AVE
Second Line :
City : VALPARAISO
State : FL
Zip : 32580-1807
Country : US
Telephone Number : 850-279-3000
Fax Number : 850-389-2269
Provider Business Practice Location Address
First Line : 80 COLLEGE BLVD E
Second Line :
City : NICEVILLE
State : FL
Zip : 32578-1343
Country : US
Telephone Number : 850-279-3000
Fax Number : 850-389-2269
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/27/2016
Last Update Date : 09/28/2023

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Directions to “ MONTANA SHADWICK BCBA” Practice Location

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