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NPI Code Detail

MEDICARE: SHAQUANE A LOUIS BEHAVIOR TECHNICIAN

MEDICARE: SHAQUANE A LOUIS BEHAVIOR TECHNICIAN
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
1376K00000XNurse's Aide
2106S00000XBehavior Technician

General Provider Information

NPI Number : 1306373402
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHAQUANE A LOUIS BEHAVIOR TECHNICIAN
Provider Business Mailing Address
First Line : 1500 S DOUGLAS RD
Second Line :
City : CORAL GABLES
State : FL
Zip : 33134-4108
Country : US
Telephone Number : 844-244-1818
Fax Number :
Provider Business Practice Location Address
First Line : 600 LAKE HOLLINGSWORTH DR
Second Line :
City : LAKELAND
State : FL
Zip : 33803-2364
Country : US
Telephone Number : 844-244-1818
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/19/2017
Last Update Date : 11/02/2023

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Directions to “ SHAQUANE A LOUIS BEHAVIOR TECHNICIAN” Practice Location

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