MEDICARE: MISS SHANTA RENA HANEY

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	RBT-25-493265	AL

General Provider Information

NPI Number	:	1740146521
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS SHANTA RENA HANEY

Provider Business Mailing Address
First Line	:	8149 OLD FEDERAL RD
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36117-8009
Country	:	US
Telephone Number	:	334-523-1331
Fax Number	:	312-929-0324

Provider Business Practice Location Address
First Line	:	8149 OLD FEDERAL RD
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36117-8009
Country	:	US
Telephone Number	:	334-523-1331
Fax Number	:	312-929-0324

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

Provider Enumeration Date	:	12/24/2025
Last Update Date	:	12/24/2025

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Directions to “ MISS SHANTA RENA HANEY ” Practice Location

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