MEDICARE: DR. SHANNON SHEA BCBA-D

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	103K00000X	Behavior Analyst	1-08-4781

General Provider Information

NPI Number	:	1245473008
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHANNON SHEA BCBA-D

Provider Business Mailing Address
First Line	:	4620 N STATE ROAD 7 STE 300
Second Line	:
City	:	LAUDERDALE LAKES
State	:	FL
Zip	:	33319-5867
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7000 W PALMETTO PARK RD STE 200
Second Line	:
City	:	BOCA RATON
State	:	FL
Zip	:	33433-3430
Country	:	US
Telephone Number	:	561-320-3240
Fax Number	:

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

Provider Enumeration Date	:	04/09/2009
Last Update Date	:	12/28/2024

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