Provider Demographics
NPI:1558422659
Name:LEVEILLE, SHANNON FARLEY (BCBA)
Entity Type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:FARLEY
Last Name:LEVEILLE
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 1:401 ANDREW JACKSON TRL
Mailing Address - Street 2:
Mailing Address - City:GULF BREEZE
Mailing Address - State:FL
Mailing Address - Zip Code:32561-4414
Mailing Address - Country:US
Mailing Address - Phone:248-798-4402
Mailing Address - Fax:
Practice Address - Street 1:3182 GULF BREEZE PKWY
Practice Address - Street 2:
Practice Address - City:GULF BREEZE
Practice Address - State:FL
Practice Address - Zip Code:32563-3248
Practice Address - Country:US
Practice Address - Phone:888-958-5753
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2017-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-14-15500103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst