MEDICARE: SHANE ALAN STEWART

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	2146	TN

General Provider Information

NPI Number	:	1679219406
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANE ALAN STEWART

Provider Business Mailing Address
First Line	:	9234 KINGSTON PIKE # 474
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37922-2380
Country	:	US
Telephone Number	:	650-437-3796
Fax Number	:

Provider Business Practice Location Address
First Line	:	9234 KINGSTON PIKE # 474
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37922-2380
Country	:	US
Telephone Number	:	650-437-3796
Fax Number	:	650-437-3796

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

Provider Enumeration Date	:	05/05/2022
Last Update Date	:	05/22/2026

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Directions to “ SHANE ALAN STEWART ” Practice Location

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