Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TB0200X | Cognitive & Behavioral Psychologist |
NPI | 1174117378 |
---|---|
Provider Name | Shellie L. Fleming |
First Address | Tavernier, FL 33070-2117 |
Second Address | Tavernier, FL 33070-3025 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/02/2021 |
Last Update Date | 28/02/2021 |