Provider Demographics
NPI:1891437190
Name:SKORNIAKOVA, ANASTASIIA D (RBT)
Entity Type:Individual
Prefix:MRS
First Name:ANASTASIIA
Middle Name:D
Last Name:SKORNIAKOVA
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 1:495 GRAND BLVD STE 206
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32550-1897
Mailing Address - Country:US
Mailing Address - Phone:850-299-4862
Mailing Address - Fax:
Practice Address - Street 1:340 SCENIC GULF DR UNIT 7
Practice Address - Street 2:
Practice Address - City:MIRAMAR BEACH
Practice Address - State:FL
Practice Address - Zip Code:32550-7022
Practice Address - Country:US
Practice Address - Phone:850-226-0176
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-08
Last Update Date:2022-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician