Provider Demographics
NPI:1033626130
Name:MOORE-HINES, SHELLYANN
Entity Type:Individual
Prefix:
First Name:SHELLYANN
Middle Name:
Last Name:MOORE-HINES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:633 NE 167TH ST STE 319
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33162-2441
Mailing Address - Country:US
Mailing Address - Phone:954-224-9827
Mailing Address - Fax:
Practice Address - Street 1:633 NE 167TH ST STE 319
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33162-2441
Practice Address - Country:US
Practice Address - Phone:954-224-9827
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-10
Last Update Date:2020-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT3428103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst