Provider Demographics
NPI:1942082524
Name:TYRYSHKINA, SESEG (RBT)
Entity Type:Individual
Prefix:
First Name:SESEG
Middle Name:
Last Name:TYRYSHKINA
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 1:301 PROCTOR DR UNIT 12107
Mailing Address - Street 2:
Mailing Address - City:WEST MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32904-4143
Mailing Address - Country:US
Mailing Address - Phone:215-920-2584
Mailing Address - Fax:
Practice Address - Street 1:550 SOLUTIONS WAY
Practice Address - Street 2:
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-3620
Practice Address - Country:US
Practice Address - Phone:321-639-9800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-18
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-23-304460106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician