Provider Demographics
NPI:1891520383
Name:PATTENGALE, ABBY LYNN
Entity type:Individual
Prefix:
First Name:ABBY
Middle Name:LYNN
Last Name:PATTENGALE
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 1:3562 D AVINCI WAY APT 2039
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-8952
Mailing Address - Country:US
Mailing Address - Phone:765-299-1718
Mailing Address - Fax:
Practice Address - Street 1:2401 W EAU GALLIE BLVD
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-2767
Practice Address - Country:US
Practice Address - Phone:132-142-5323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-04
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician