MEDICARE: SHANTEL FARRAR BCBA

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	0133003256	VA

General Provider Information

NPI Number	:	1770363822
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANTEL FARRAR BCBA

Provider Business Mailing Address
First Line	:	314 RIDGELY ST
Second Line	:
City	:	LARGO
State	:	MD
Zip	:	20774-1929
Country	:	US
Telephone Number	:	301-254-3354
Fax Number	:

Provider Business Practice Location Address
First Line	:	314 RIDGELY ST
Second Line	:
City	:	LARGO
State	:	MD
Zip	:	20774-1929
Country	:	US
Telephone Number	:	301-254-3354
Fax Number	:

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

Provider Enumeration Date	:	10/04/2023
Last Update Date	:	10/16/2024

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