Provider Demographics
NPI:1780394841
Name:RODRIGUEZ, SHAVANA (BEHAVIOR TECHNICIAN)
Entity type:Individual
Prefix:
First Name:SHAVANA
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:BEHAVIOR TECHNICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3994 PORTA TRIESTE LOOP APT 103
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33909-5478
Mailing Address - Country:US
Mailing Address - Phone:239-672-6915
Mailing Address - Fax:
Practice Address - Street 1:3994 PORTA TRIESTE LOOP APT 103
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33909-5478
Practice Address - Country:US
Practice Address - Phone:239-672-6915
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-30
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-22-245092106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician