Bridget Anita Shore, BCBA-D

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

License

1-04-1993 Issued in FL

Practice address

2050 Classique LN
Tavares, FL 32778-5787

Phone

(352) 508-5243

NPI assigned

May 17, 2017

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Behavior Services of Brevard County

  • Behavior Analyst
  • Rockledge, FL
  • NPI 1750828323
  NPD (past)

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

{
    "created_epoch": "1494979200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1494979200000",
    "number": "1255868626",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "36227 E ELDORADO LAKE DR",
            "city": "EUSTIS",
            "state": "FL",
            "postal_code": "327369474",
            "telephone_number": "941-357-6840",
            "fax_number": "352-602-4145"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2050 CLASSIQUE LN",
            "city": "TAVARES",
            "state": "FL",
            "postal_code": "327785787",
            "telephone_number": "352-508-5243"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHORE",
        "first_name": "BRIDGET",
        "middle_name": "ANITA",
        "credential": "BCBA-D",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-05-17",
        "last_updated": "2017-05-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "FL",
            "license": "1-04-1993",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tiffany Leeann Semento
• Serene Diagnostic Imaging Corp
• Jigna Hitesh Shah, M.D.
• Marcia Shapiro
• Cameika Odelvez Shepherd, APRN
• Dean Henry Short, RPH
• Kathleen Siegfried, M.S.
• Sarah Margaret Simmons, ARNP
• Brittany Nichols Simpson, APRN
• Ravinder Singh, M.D.

• Behavior Analyst in Tavares, FL
• Providers in Tavares, FL by specialty
• Behavior Analyst in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 17, 2017; 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.