MEDICARE: SHAMAR NATION

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

General Provider Information

NPI Number	:	1770121618
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAMAR NATION

Provider Business Mailing Address
First Line	:	21600 OXNARD ST
Second Line	:
City	:	WOODLAND HILLS
State	:	CA
Zip	:	91367-4976
Country	:	US
Telephone Number	:	818-345-2345
Fax Number	:

Provider Business Practice Location Address
First Line	:	12740 BANDERA RD
Second Line	:	SUITE 200
City	:	SAN ANTONIO
State	:	TX
Zip	:	78249-7824
Country	:	US
Telephone Number	:	210-321-9275
Fax Number	:

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

Provider Enumeration Date	:	12/11/2019
Last Update Date	:	12/11/2019

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Directions to “ SHAMAR NATION ” Practice Location

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