Provider Demographics
NPI:1245764802
Name:SHELTON, AUBRIANNA
Entity Type:Individual
Prefix:
First Name:AUBRIANNA
Middle Name:
Last Name:SHELTON
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 1:5246 RISHLEY RUN WAY
Mailing Address - Street 2:
Mailing Address - City:MOUNT DORA
Mailing Address - State:FL
Mailing Address - Zip Code:32757-8014
Mailing Address - Country:US
Mailing Address - Phone:352-348-0116
Mailing Address - Fax:
Practice Address - Street 1:851 N DONNELLY ST STE 10
Practice Address - Street 2:
Practice Address - City:MOUNT DORA
Practice Address - State:FL
Practice Address - Zip Code:32757
Practice Address - Country:US
Practice Address - Phone:844-668-6222
Practice Address - Fax:888-975-0599
Is Sole Proprietor?:No
Enumeration Date:2017-04-20
Last Update Date:2018-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-17-36295106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician