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NPI Code Detail

MEDICARE: SHARKY HEARTS BEHAVIOR SUPPORT SERVICES LLC

MEDICARE: SHARKY HEARTS BEHAVIOR SUPPORT SERVICES LLC
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 Analyst

General Provider Information

NPI Number : 1659029726
Entity Type Code : Organization
Provider Name (Legal Business Name) : SHARKY HEARTS BEHAVIOR SUPPORT SERVICES LLC
Provider Business Mailing Address
First Line : 74-5078 KUMAKANI ST
Second Line :
City : KAILUA KONA
State : HI
Zip : 96740-1530
Country : US
Telephone Number : 808-746-1779
Fax Number :
Provider Business Practice Location Address
First Line : 74-5078 KUMAKANI ST
Second Line :
City : KAILUA KONA
State : HI
Zip : 96740-1530
Country : US
Telephone Number : 808-746-1779
Fax Number :
Authorized Official
Title or Position : BOARD CERTIFIED BEHAVIOR ANALYST
Name : PAIGE STEGEMAN
Credential : BCBA, LBA
Telephone Number : 808-746-1779
Provider Enumeration Date : 03/16/2022
Last Update Date : 03/16/2022

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Directions to “SHARKY HEARTS BEHAVIOR SUPPORT SERVICES LLC ” Practice Location

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