Provider Demographics
NPI:1437965043
Name:SHEA, EILEEN M (RBT)
Entity type:Individual
Prefix:
First Name:EILEEN
Middle Name:M
Last Name:SHEA
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 1:7673 PARKVIEW WAY
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065-6025
Mailing Address - Country:US
Mailing Address - Phone:914-844-0220
Mailing Address - Fax:
Practice Address - Street 1:4701 N FEDERAL HWY STE 460
Practice Address - Street 2:
Practice Address - City:LIGHTHOUSE POINT
Practice Address - State:FL
Practice Address - Zip Code:33064-6591
Practice Address - Country:US
Practice Address - Phone:954-866-1430
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-09
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-398251106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician