Shayla Renee Ellis, MS, BCBA

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

License

1-08-4580 Issued in FL

Practice address

8027 Cooper Creek Blvd Ste 103
University Park, FL 34201-3002

Phone

(941) 477-2080

Fax

(317) 520-8200

NPI assigned

Oct 8, 2008

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

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.

• Progress Path ABA Therapy LLC

  • Behavior Analyst
  • Palmetto, FL
  • NPI 1417603564
  NPD Authorized official
• Cerebrum Healthcare LLC

  • Neurology Physician
  • Tampa, FL
  • NPI 1255849055
  NPD (past)
• Parc Inc

  • Intellectual Disabilities Intermediate Care Facility
  • St Petersburg, FL
  • NPI 1477680916
  NPD (past)

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

{
    "created_epoch": "1223424000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1650412800000",
    "number": "1679724520",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3500 DEPAUW BLVD STE 3070",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462686135",
            "telephone_number": "855-324-0885",
            "fax_number": "317-520-8200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8027 COOPER CREEK BLVD STE 103",
            "city": "UNIVERSITY PARK",
            "state": "FL",
            "postal_code": "342013002",
            "telephone_number": "941-477-2080",
            "fax_number": "317-520-8200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLIS",
        "first_name": "SHAYLA",
        "middle_name": "RENEE",
        "name_prefix": "Mrs.",
        "credential": "MS, BCBA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-10-08",
        "last_updated": "2022-04-20",
        "certification_date": "2022-04-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "FL",
            "license": "1-08-4580",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "024004496",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kassandra Dionne
• Dixon Dental Concepts Inc
• Raymond Dustin Dixon, DMD
• Luciel Eldeek
• Aiyanna Ellis
• Eyecare Partners of Southwest Florida LLC
• Ryan Alexander Falk, PHARMD
• Family Medicine Specialists, PLLC
• Kirsten Foullong, DC
• Fresenius Medical Care North Sarasota, LLC

• Behavior Analyst in University Park, FL
• Providers in University Park, FL by specialty
• Behavior Analyst in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2022; 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.