Shanna Marie Smith

Primary specialty

Behavior TechnicianTaxonomy code 106S00000X

Practice address

1331 Creighton Rd Ste B
Pensacola, FL 32504-9403

Phone

(850) 450-8838

NPI assigned

Apr 20, 2021

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Shanna Marie Gravitt Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1618876800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1618876800000",
    "number": "1003497108",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6185 TISDALE LN",
            "city": "PENSACOLA",
            "state": "FL",
            "postal_code": "325264291",
            "telephone_number": "850-450-8838"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1331 CREIGHTON RD STE B",
            "city": "PENSACOLA",
            "state": "FL",
            "postal_code": "325049403",
            "telephone_number": "850-450-8838"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "SHANNA",
        "middle_name": "MARIE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-04-20",
        "last_updated": "2021-04-20",
        "certification_date": "2021-04-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "107288400",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SHANNA",
            "last_name": "GRAVITT",
            "middle_name": "MARIE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Rick D Smith, M.D.
• Robert M Smith II, MD
• Robert Paul Smith II, AU.D.
• Sarah E Smith
• Sarah Gibson Smith, MSW
• Shannon Victoria Smith, PHARM.D.
• Stephen Estes Smith, DMD
• Sue L Smith
• Susan L Smith, MD
• Terri Barnes Smith, RPH

• Behavior Technician in Pensacola, FL
• Providers in Pensacola, FL by specialty
• Behavior Technician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.