Provider Demographics
NPI:1225439086
Name:MCKINNEY, SHAVONA (MS, LBS)
Entity Type:Individual
Prefix:
First Name:SHAVONA
Middle Name:
Last Name:MCKINNEY
Suffix:
Gender:F
Credentials:MS, LBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 N RAMUNNO DR
Mailing Address - Street 2:UNIT 2311
Mailing Address - City:MIDDLETOWN
Mailing Address - State:DE
Mailing Address - Zip Code:19709-3003
Mailing Address - Country:US
Mailing Address - Phone:302-373-5924
Mailing Address - Fax:
Practice Address - Street 1:410 N RAMUNNO DR
Practice Address - Street 2:UNIT 2311
Practice Address - City:MIDDLETOWN
Practice Address - State:DE
Practice Address - Zip Code:19709-3003
Practice Address - Country:US
Practice Address - Phone:302-373-5924
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-11
Last Update Date:2014-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABH002471103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst