Provider Demographics
NPI:1548548316
Name:RUNION, SHERRY (BCBA)
Entity type:Individual
Prefix:
First Name:SHERRY
Middle Name:
Last Name:RUNION
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5308 ECHO PINES CIR W
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34951-3320
Mailing Address - Country:US
Mailing Address - Phone:913-360-0908
Mailing Address - Fax:913-360-0908
Practice Address - Street 1:2400 SE FEDERAL HWY STE 220
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-4556
Practice Address - Country:US
Practice Address - Phone:913-360-0908
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-28
Last Update Date:2019-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-16-24688103K00000X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL019919800Medicaid