Provider Demographics
NPI:1134992068
Name:GONSALVES, SHAUN ANDREA (RBT)
Entity type:Individual
Prefix:MS
First Name:SHAUN
Middle Name:ANDREA
Last Name:GONSALVES
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 1:6837 REMBRANDT DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32818-1342
Mailing Address - Country:US
Mailing Address - Phone:321-732-2819
Mailing Address - Fax:
Practice Address - Street 1:6837 REMBRANDT DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32818-1342
Practice Address - Country:US
Practice Address - Phone:321-732-2819
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-02
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT23-308006106S00000X
106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician