Provider Demographics
NPI:1891320594
Name:SCRIVEN, SHANNON MELISSA
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:MELISSA
Last Name:SCRIVEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14817 BALGOWAN RD APT 104-5
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33016-6471
Mailing Address - Country:US
Mailing Address - Phone:954-400-8748
Mailing Address - Fax:
Practice Address - Street 1:14817 BALGOWAN RD APT 104-5
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33016-6471
Practice Address - Country:US
Practice Address - Phone:954-400-8748
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-03
Last Update Date:2020-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician