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NPI Code Detail

MEDICARE: SHANESE BALDRIDGE

MEDICARE: SHANESE BALDRIDGE
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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1750934790
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHANESE BALDRIDGE
Provider Business Mailing Address
First Line : 741 SUMMER PARK DR
Second Line :
City : STAFFORD
State : TX
Zip : 77477-5553
Country : US
Telephone Number : 832-236-6522
Fax Number :
Provider Business Practice Location Address
First Line : 6914 BRISBANE CT STE 201
Second Line :
City : SUGAR LAND
State : TX
Zip : 77479-4924
Country : US
Telephone Number : 844-272-7223
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/18/2019
Last Update Date : 07/18/2019

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Directions to “ SHANESE BALDRIDGE ” Practice Location

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