Provider Demographics
NPI:1235971292
Name:HALLETT, DARBY SHANNON
Entity type:Individual
Prefix:
First Name:DARBY
Middle Name:SHANNON
Last Name:HALLETT
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:PANTOGRAM LLC CENTER FOR AUTISM (CARD)
Mailing Address - Street 2:996 ROYAL MARCO WAY
Mailing Address - City:MARCO ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:34145
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:PANTOGRAM LLC CENTER FOR AUTISM (CARD)
Practice Address - Street 2:996 ROYAL MARCO WAY
Practice Address - City:MARCO ISLAND
Practice Address - State:FL
Practice Address - Zip Code:34145
Practice Address - Country:US
Practice Address - Phone:360-605-1881
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-11
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician