Provider Demographics
NPI:1588298277
Name:WISHARD, CHELSEY DANELLE (RBT)
Entity type:Individual
Prefix:
First Name:CHELSEY
Middle Name:DANELLE
Last Name:WISHARD
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2675 HORSESHOE DR S STE 404
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34104-6155
Mailing Address - Country:US
Mailing Address - Phone:800-217-9289
Mailing Address - Fax:
Practice Address - Street 1:8245 VICELA DR
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34240-1462
Practice Address - Country:US
Practice Address - Phone:239-778-7490
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-03
Last Update Date:2020-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-19-96512106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician