Provider Demographics
NPI:1952894123
Name:ALFORD, SHANTELLE CYMONE
Entity Type:Individual
Prefix:
First Name:SHANTELLE
Middle Name:CYMONE
Last Name:ALFORD
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 1:3282 OAK LAKE PL
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-6587
Mailing Address - Country:US
Mailing Address - Phone:407-491-7795
Mailing Address - Fax:
Practice Address - Street 1:3282 OAK LAKE PL
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-6587
Practice Address - Country:US
Practice Address - Phone:407-491-7795
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-12
Last Update Date:2018-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst