Provider Demographics
NPI:1366999609
Name:MASHKOW, PATRICIA DIANE
Entity type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:DIANE
Last Name:MASHKOW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2098 MAEVE CIR
Mailing Address - Street 2:
Mailing Address - City:WEST MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32904-7356
Mailing Address - Country:US
Mailing Address - Phone:772-913-0074
Mailing Address - Fax:
Practice Address - Street 1:2098 MAEVE CIR
Practice Address - Street 2:
Practice Address - City:WEST MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32904-7356
Practice Address - Country:US
Practice Address - Phone:772-913-0074
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-03
Last Update Date:2016-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst