MEDICARE: SHAY MOLINA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1073345120
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAY MOLINA

Provider Business Mailing Address
First Line	:	21045 N 9TH PL STE 204
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85024-5635
Country	:	US
Telephone Number	:	520-505-2810
Fax Number	:

Provider Business Practice Location Address
First Line	:	2090 N KOLB RD STE 100
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85715-4149
Country	:	US
Telephone Number	:	520-505-2810
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/16/2024
Last Update Date	:	08/16/2024

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Directions to “ SHAY MOLINA ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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