MEDICARE: WYATT JOEL SHEALY

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
1	106E00000X	Assistant Behavior Analyst		FL

General Provider Information

NPI Number	:	1235091836
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WYATT JOEL SHEALY

Provider Business Mailing Address
First Line	:	7108 S KANNER HWY
Second Line	:
City	:	STUART
State	:	FL
Zip	:	34997-7462
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	907 OUTER RD STE B
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32814-6601
Country	:	US
Telephone Number	:	855-832-6727
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/02/2025
Last Update Date	:	12/02/2025

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Directions to “ WYATT JOEL SHEALY ” Practice Location

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