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NPI Code Detail

MEDICARE: SHANNON DOBSON BCBA

MEDICARE: SHANNON DOBSON BCBA
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
1103K00000XBehavior Analyst12471805NC

General Provider Information

NPI Number : 1235977752
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHANNON DOBSON BCBA
Provider Business Mailing Address
First Line : 1405 S BROAD ST
Second Line :
City : WINSTON SALEM
State : NC
Zip : 27127-2068
Country : US
Telephone Number : 855-772-8847
Fax Number :
Provider Business Practice Location Address
First Line : 1405 S BROAD ST
Second Line :
City : WINSTON SALEM
State : NC
Zip : 27127-2068
Country : US
Telephone Number : 855-772-8847
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/18/2024
Last Update Date : 03/18/2026

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