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NPI Code Detail

MEDICARE: SHANNON HARRIS BCBA

MEDICARE: SHANNON HARRIS BCBA
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
1103K00000XBehavior Analyst1-15-19565GA
2103K00000XBehavior Analyst11519565FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11-15-19565OTHERGABACB

General Provider Information

NPI Number : 1891153086
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHANNON HARRIS BCBA
Provider Business Mailing Address
First Line : 6867 SOUTHPOINT DR N STE 101
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32216-8005
Country : US
Telephone Number : 904-619-6071
Fax Number : 904-212-0309
Provider Business Practice Location Address
First Line : 6505 SHILOH RD STE 100
Second Line :
City : ALPHARETTA
State : GA
Zip : 30005-1645
Country : US
Telephone Number : 678-648-7644
Fax Number : 678-648-7479
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/03/2016
Last Update Date : 05/08/2019

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