Provider Demographics
NPI:1851044267
Name:HAYNES, SHANNON CHRISTINE (RBT)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:CHRISTINE
Last Name:HAYNES
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 1:160 E LAKE BRANTLEY DR
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32779-4807
Mailing Address - Country:US
Mailing Address - Phone:321-972-6720
Mailing Address - Fax:321-295-7027
Practice Address - Street 1:160 E LAKE BRANTLEY DR
Practice Address - Street 2:
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32779-4807
Practice Address - Country:US
Practice Address - Phone:321-972-6720
Practice Address - Fax:321-295-7027
Is Sole Proprietor?:No
Enumeration Date:2022-01-27
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician