MEDICARE: SHONTA BEATRICE ROWE

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	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1275042640
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHONTA BEATRICE ROWE

Provider Business Mailing Address
First Line	:	310 E 7TH ST
Second Line	:
City	:	LYNN HAVEN
State	:	FL
Zip	:	32444-1822
Country	:	US
Telephone Number	:	850-625-3470
Fax Number	:

Provider Business Practice Location Address
First Line	:	1137 HARRISON AVE STE 13A
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32401-2498
Country	:	US
Telephone Number	:	850-778-2233
Fax Number	:	850-778-2233

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

Provider Enumeration Date	:	09/28/2017
Last Update Date	:	09/28/2017

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Directions to “ SHONTA BEATRICE ROWE ” Practice Location

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