Provider Demographics
NPI:1386013951
Name:PANNO, SHEILA (BS, RBT)
Entity Type:Individual
Prefix:
First Name:SHEILA
Middle Name:
Last Name:PANNO
Suffix:
Gender:F
Credentials:BS, RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2597 COUNTRYSIDE BLVD
Mailing Address - Street 2:#101
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33761-4522
Mailing Address - Country:US
Mailing Address - Phone:727-331-9192
Mailing Address - Fax:
Practice Address - Street 1:2597 COUNTRYSIDE BLVD
Practice Address - Street 2:#101
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33761-4522
Practice Address - Country:US
Practice Address - Phone:727-331-9192
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-24
Last Update Date:2015-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLBACB293269103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst