MEDICARE: ALYSON MACKENZIE SHOCKEY

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		VA

General Provider Information

NPI Number	:	1720934987
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALYSON MACKENZIE SHOCKEY

Provider Business Mailing Address
First Line	:	1500 S DOUGLAS RD # 230
Second Line	:
City	:	CORAL GABLES
State	:	FL
Zip	:	33134-4108
Country	:	US
Telephone Number	:	786-751-4534
Fax Number	:

Provider Business Practice Location Address
First Line	:	11 HOPE RD
Second Line	:
City	:	STAFFORD
State	:	VA
Zip	:	22554-7287
Country	:	US
Telephone Number	:	540-709-8995
Fax Number	:

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

Provider Enumeration Date	:	03/09/2026
Last Update Date	:	03/12/2026

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