Basic Information
| Provider Information | |||||||||
| NPI: | 1558422659 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LEVEILLE | ||||||||
| FirstName: | SHANNON | ||||||||
| MiddleName: | FARLEY | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | BCBA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 401 ANDREW JACKSON TRL | ||||||||
| Address2: | |||||||||
| City: | GULF BREEZE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 325614414 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2487984402 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3182 GULF BREEZE PKWY | ||||||||
| Address2: | |||||||||
| City: | GULF BREEZE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 325633248 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8889585753 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/12/2006 | ||||||||
| LastUpdateDate: | 01/09/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | 1-14-15500 | FL | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.