Provider Demographics
NPI:1093012007
Name:PARDUE, SHANNON DIANNE (BCBA)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:DIANNE
Last Name:PARDUE
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5881 DANDELION LN
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32526-9454
Mailing Address - Country:US
Mailing Address - Phone:850-458-7825
Mailing Address - Fax:
Practice Address - Street 1:5881 DANDELION LN
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32526-9454
Practice Address - Country:US
Practice Address - Phone:850-458-7825
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-28
Last Update Date:2011-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-11-8079103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst