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NPI Code Detail

MEDICARE: SHANNON SOUZA

MEDICARE: SHANNON SOUZA
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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1912859133
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHANNON SOUZA
Provider Business Mailing Address
First Line : 300 INTERNATIONAL PKWY STE 200
Second Line :
City : LAKE MARY
State : FL
Zip : 32746-5028
Country : US
Telephone Number : 866-610-0580
Fax Number : 866-611-1558
Provider Business Practice Location Address
First Line : 247 SW PORT ST LUCIE BLVD
Second Line :
City : PORT SAINT LUCIE
State : FL
Zip : 34984-5015
Country : US
Telephone Number : 772-207-1356
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/11/2026
Last Update Date : 03/05/2026

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Directions to “ SHANNON SOUZA ” Practice Location

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