Shannon Rae Banaszak
Individual provider Active NPI Behavior Technician · Crestview, FL
NPI 1861171852 · NPPES record last updated Jul 17, 2023
Key facts
- NPI
- 1861171852
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Behavior Technician 106S00000X
- Practice address
- 851 N Wilson St
Crestview, FL 32536-2639 - Phone
- (850) 607-6910
- Fax
- (850) 607-6932
- NPI assigned
- Jul 17, 2023
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | Yes |
Addresses
Primary practice location
851 N Wilson St
Crestview, FL 32536-2639
Mailing address
9900 N Davis Hwy
Pensacola, FL 32514-8124
Other providers in Crestview, FL
- Kaitlen Autrey
- Muhammad Azzam Awan
- Monica L Baker
- Connie Dennise Baldwin
- Jill Ballantyne
- Glenn M Bankert
- Beverly H. Barbarisi
- Barbee Medical Group LLC
- Kimberly Barberree
- Diadema G Barefield
All providers in Crestview, FL · Behavior Technician in Florida
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 17, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.