Provider Demographics
NPI:1003370420
Name:WEIRICH, SCHYLAR MICHAEL
Entity Type:Individual
Prefix:
First Name:SCHYLAR
Middle Name:MICHAEL
Last Name:WEIRICH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4125 BAIR AVE
Mailing Address - Street 2:
Mailing Address - City:FRUITLAND PARK
Mailing Address - State:FL
Mailing Address - Zip Code:34731-5617
Mailing Address - Country:US
Mailing Address - Phone:352-874-0170
Mailing Address - Fax:
Practice Address - Street 1:4125 BAIR AVE
Practice Address - Street 2:
Practice Address - City:FRUITLAND PARK
Practice Address - State:FL
Practice Address - Zip Code:34731-5617
Practice Address - Country:US
Practice Address - Phone:352-874-0170
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-30
Last Update Date:2019-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-18-70698106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician