Active NPI
Sa-Shawna Scully
- Behavior Technician
- Port St Lucie, FL
National Provider Identifier
1811408321
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- Practice address
- 247 SW Port St Lucie Blvd
Port St Lucie, FL 34984-5015 - Phone
- (772) 207-1356
- NPI assigned
- Oct 24, 2017
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | Primary |
Addresses
Primary practice location
247 SW Port St Lucie Blvd
Port St Lucie, FL 34984-5015
Mailing address
1438 SW Medina Ave
Port Saint Lucie, FL 34953-4918
Phone (954) 756-0543
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 020089000 | Medicaid | FL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1508803200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1568073600000",
"number": "1811408321",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1438 SW MEDINA AVE",
"city": "PORT SAINT LUCIE",
"state": "FL",
"postal_code": "349534918",
"telephone_number": "954-756-0543"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "247 SW PORT ST LUCIE BLVD",
"city": "PORT ST LUCIE",
"state": "FL",
"postal_code": "349845015",
"telephone_number": "772-207-1356"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SCULLY",
"first_name": "SA-SHAWNA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-10-24",
"last_updated": "2019-09-10",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "020089000",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Port St Lucie, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.