Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106E00000X | Assistant Behavior Analyst | 0-15-6915 |
NPI | 1043557143 |
---|---|
Provider Name | Shelley Sgrulloni |
First Address | Casselberry, FL 32707-5372 |
Second Address | Apopka, FL 32712-3645 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/01/2013 |
Last Update Date | 28/12/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
S645783897570 | DRIVER'S LICENSE (01) | FL |