Fentress, Shana

Fentress, Shana is an individual health care provider with primary practice located at 1887 Se Port St Lucie Blvd , Port St Lucie FL 34952-5530. She recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Behavior Technician, Behavioral Health & Social Service Providers / Behavioral Analyst. Behavioral Health & Social Service Providers / Behavioral Analyst is her primary health care specialty. Fentress, Shana can be contacted via phone (772) 463-0444.

Contact Information

Primary practice address
1887 Se Port St Lucie Blvd Port St Lucie FL 34952-5530
Phone: (772) 463-0444
Fax: (772) 219-1339
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Behavior Technician 106S00000X RBT-17-30488 Florida
Behavioral Health & Social Service Providers / Behavioral Analyst 103K00000X 1-18-33526 Florida

Profile Details

NPI number 1902358708
LBN Legal business name Fentress, Shana
Credentials BCBA
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 27th, 2016
Last updated Nov 21st, 2023 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1902358708 NPPES
Florida MEDICAID 019859300

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