MEDICARE: SHALIYAH OVID

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

General Provider Information

NPI Number	:	1902697998
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHALIYAH OVID

Provider Business Mailing Address
First Line	:	2563 BOGAN BRIDGE CIR
Second Line	:
City	:	BUFORD
State	:	GA
Zip	:	30519-4575
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	629 AIRPORT RD STE P
Second Line	:
City	:	LAWRENCEVILLE
State	:	GA
Zip	:	30046-4474
Country	:	US
Telephone Number	:	678-255-0597
Fax Number	:

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

Provider Enumeration Date	:	05/16/2025
Last Update Date	:	05/16/2025

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Directions to “ SHALIYAH OVID ” Practice Location

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