Provider Demographics
NPI:1114496692
Name:ROBERTS, SHAWN D (RBT)
Entity Type:Individual
Prefix:MR
First Name:SHAWN
Middle Name:D
Last Name:ROBERTS
Suffix:
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 WILDWOOD LN
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32137-3221
Mailing Address - Country:US
Mailing Address - Phone:386-227-6485
Mailing Address - Fax:866-247-1790
Practice Address - Street 1:8 WILDWOOD LN
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32137-3221
Practice Address - Country:US
Practice Address - Phone:386-227-6485
Practice Address - Fax:866-247-1790
Is Sole Proprietor?:No
Enumeration Date:2018-11-14
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician