Shannon Rae Banaszak

NPI #1861171852 in Crestview, Florida

Provider Information

NPI Number: 1861171852
Entity Type: Individual
Name: Shannon Rae Banaszak
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Behavior Technician
Enumeration Date: Jul 17, 2023
Last Updated: Jul 17, 2023

Practice Location

Address: 851 N WILSON ST
City: Crestview
State: Florida
ZIP Code: 32536-2639
Phone: (850) 607-6910

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Behavior Technician	106S00000X	Primary

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