Provider Demographics
NPI:1700152386
Name:ANTHONY, SHAKEVIA RENA
Entity Type:Individual
Prefix:
First Name:SHAKEVIA
Middle Name:RENA
Last Name:ANTHONY
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 1:950 PACES CIR
Mailing Address - Street 2:APT 308
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32703-8619
Mailing Address - Country:US
Mailing Address - Phone:954-483-1005
Mailing Address - Fax:
Practice Address - Street 1:950 PACES CIR
Practice Address - Street 2:APT 308
Practice Address - City:APOPKA
Practice Address - State:FL
Practice Address - Zip Code:32703-8619
Practice Address - Country:US
Practice Address - Phone:954-483-1005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-28
Last Update Date:2016-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst