Provider Demographics
NPI:1407103963
Name:PRIDGEN, SHARI (BCBA)
Entity Type:Individual
Prefix:
First Name:SHARI
Middle Name:
Last Name:PRIDGEN
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 1:1112 WOODBINE CT
Mailing Address - Street 2:
Mailing Address - City:FERN PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32730-2903
Mailing Address - Country:US
Mailing Address - Phone:904-707-5353
Mailing Address - Fax:
Practice Address - Street 1:1112 WOODBINE CT
Practice Address - Street 2:
Practice Address - City:FERN PARK
Practice Address - State:FL
Practice Address - Zip Code:32730-2903
Practice Address - Country:US
Practice Address - Phone:904-707-5353
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-14
Last Update Date:2021-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0125055103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst