Provider Demographics
NPI:1386163749
Name:SCHLEIDER, KEVIN ALLEN
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:ALLEN
Last Name:SCHLEIDER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1937 NW AZALEA ST
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34994-9201
Mailing Address - Country:US
Mailing Address - Phone:772-342-2148
Mailing Address - Fax:
Practice Address - Street 1:1365 SW VIZCAYA CIR
Practice Address - Street 2:
Practice Address - City:PALM CITY
Practice Address - State:FL
Practice Address - Zip Code:34990-1962
Practice Address - Country:US
Practice Address - Phone:772-349-1186
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-15
Last Update Date:2017-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL684179Medicaid