Provider Demographics
NPI:1619750064
Name:SHALLIE, LLC
Entity Type:Organization
Organization Name:SHALLIE, LLC
Other - Org Name:ALL ABOUT BEHAVIOR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHAVETA
Authorized Official - Middle Name:
Authorized Official - Last Name:SURI
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:407-731-0940
Mailing Address - Street 1:305 WAYMONT CT
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-3566
Mailing Address - Country:US
Mailing Address - Phone:407-731-0940
Mailing Address - Fax:
Practice Address - Street 1:305 WAYMONT CT
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-3566
Practice Address - Country:US
Practice Address - Phone:407-731-0940
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-17
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty