Provider Demographics
NPI:1881873727
Name:LYONS, EBONI N (BS)
Entity type:Individual
Prefix:MISS
First Name:EBONI
Middle Name:N
Last Name:LYONS
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3487 SHORTLEAF CT APT U6
Mailing Address - Street 2:
Mailing Address - City:CANTONMENT
Mailing Address - State:FL
Mailing Address - Zip Code:32533-8449
Mailing Address - Country:US
Mailing Address - Phone:850-284-2093
Mailing Address - Fax:
Practice Address - Street 1:3487 SHORTLEAF CT
Practice Address - Street 2:
Practice Address - City:CANTONMENT
Practice Address - State:FL
Practice Address - Zip Code:32533-8449
Practice Address - Country:US
Practice Address - Phone:850-284-2093
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-28
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist