Provider Demographics
NPI:1700189545
Name:ALLEN, ALISHA N (MD, BCBA)
Entity Type:Individual
Prefix:DR
First Name:ALISHA
Middle Name:N
Last Name:ALLEN
Suffix:
Gender:F
Credentials:MD, BCBA
Other - Prefix:
Other - First Name:LYAH
Other - Middle Name:
Other - Last Name:ALLEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:BROWARD HEALTH MEDICAL CENTER
Mailing Address - Street 2:1600 S ANDREWS AVE
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33316
Mailing Address - Country:US
Mailing Address - Phone:954-335-4400
Mailing Address - Fax:
Practice Address - Street 1:1600 S ANDREWS AVE
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33316-2510
Practice Address - Country:US
Practice Address - Phone:954-335-4400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-17
Last Update Date:2021-08-09
Deactivation Date:2021-03-29
Deactivation Code:
Reactivation Date:2021-08-03
Provider Licenses
StateLicense IDTaxonomies
FLTRN33942390200000X
103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst