Provider Demographics
NPI:1205311446
Name:CRESPO, SHEYENNE
Entity type:Individual
Prefix:
First Name:SHEYENNE
Middle Name:
Last Name:CRESPO
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 1:1863 MECKLENBURG HWY
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28115-8576
Mailing Address - Country:US
Mailing Address - Phone:386-451-0982
Mailing Address - Fax:
Practice Address - Street 1:900 BRANCHVIEW DR NE STE 200
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-2226
Practice Address - Country:US
Practice Address - Phone:386-451-0982
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-02
Last Update Date:2019-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician