Provider Demographics
NPI:1871063396
Name:SULLIVAN, STEPHANIE ASHLEIGH (RBT)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:ASHLEIGH
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 S TUBB ST STE A1
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:FL
Mailing Address - Zip Code:34760-8859
Mailing Address - Country:US
Mailing Address - Phone:407-395-9976
Mailing Address - Fax:497-992-9368
Practice Address - Street 1:301 S TUBB ST STE A1
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:FL
Practice Address - Zip Code:34760-8859
Practice Address - Country:US
Practice Address - Phone:407-395-9976
Practice Address - Fax:407-992-9368
Is Sole Proprietor?:No
Enumeration Date:2018-11-27
Last Update Date:2018-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician