MEDICARE: JASON SHUTE 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
1	103K00000X	Behavior Analyst

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	042197449	OTHER	MA	TRICARE

General Provider Information

NPI Number	:	1457672214
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JASON SHUTE BCBA

Provider Business Mailing Address
First Line	:	135 MCKEAGNEY RD
Second Line	:
City	:	MILTON
State	:	NH
Zip	:	03851-4815
Country	:	US
Telephone Number	:	603-507-8800
Fax Number	:

Provider Business Practice Location Address
First Line	:	35 INDUSTRIAL WAY STE 15
Second Line	:
City	:	ROCHESTER
State	:	NH
Zip	:	03867-6202
Country	:	US
Telephone Number	:	561-323-6593
Fax Number	:

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

Provider Enumeration Date	:	06/16/2010
Last Update Date	:	09/12/2025

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