Individual
MS. SHANTANEAST ROSALEE BLAKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
763 53RD TER N, SAINT PETERSBURG, FL 33703-2839
(727) 564-2126
(727) 564-2126
Mailing address
763 53RD TER N, SAINT PETERSBURG, FL 33703-2839
(727) 564-2126
Taxonomy
Speciality
Code
Description
License number
State
106E00000X
Assistant Behavior Analyst
Primary
—
—
Other
Enumeration date
11/27/2017
Last updated
11/27/2017
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