Provider Demographics
NPI:1497468276
Name:SANDY, SHASA (RBT)
Entity Type:Individual
Prefix:
First Name:SHASA
Middle Name:
Last Name:SANDY
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8436 SILVERBELL LOOP
Mailing Address - Street 2:
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34613-6843
Mailing Address - Country:US
Mailing Address - Phone:352-770-3735
Mailing Address - Fax:
Practice Address - Street 1:9405 BARNSTEAD LN
Practice Address - Street 2:
Practice Address - City:PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34668-4302
Practice Address - Country:US
Practice Address - Phone:727-967-2809
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-27
Last Update Date:2022-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician