Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | FL | |
N | 106E00000X | Assistant Behavior Analyst | 508 | FL |
NPI | 1093395626 |
---|---|
Provider Name | Ms. Shelby C Burdette |
First Address | Port Orange, FL 32128-6096 |
Second Address | Port Orange, FL 32128-6096 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/04/2021 |
Last Update Date | 20/07/2021 |