Provider Demographics
NPI:1164243846
Name:ROGERS, SHAYNA (MED, BCBA)
Entity type:Individual
Prefix:
First Name:SHAYNA
Middle Name:
Last Name:ROGERS
Suffix:
Gender:F
Credentials:MED, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9100 REGENCY SQUARE BLVD N
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32211-8103
Mailing Address - Country:US
Mailing Address - Phone:904-288-7259
Mailing Address - Fax:
Practice Address - Street 1:9100 REGENCY SQUARE BLVD N
Practice Address - Street 2:N/A
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32211-8103
Practice Address - Country:US
Practice Address - Phone:904-288-7259
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-24
Last Update Date:2024-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-24-75776103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst