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NPI Code Detail

MEDICARE: SHANNON WILLIAMS KANG MED., BCBA

MEDICARE: SHANNON WILLIAMS KANG MED., 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 Analyst1-19-39508FL

General Provider Information

NPI Number : 1053894923
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHANNON WILLIAMS KANG MED., BCBA
Provider Business Mailing Address
First Line : PO BOX 10827
Second Line :
City : TALLAHASSEE
State : FL
Zip : 32302-2827
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2928 WELLINGTON CIR STE 201
Second Line :
City : TALLAHASSEE
State : FL
Zip : 32309-6879
Country : US
Telephone Number : 850-521-0242
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/07/2018
Last Update Date : 12/09/2025

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