Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst |
NPI | 1003476037 |
---|---|
Provider Name | Shelby Brand |
First Address | Indianapolis, IN 46220-1907 |
Second Address | Bedford, MA 01730-1423 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2019 |
Last Update Date | 20/06/2019 |