Healthcare Provider Details

I. General information

NPI: 1013834118
Provider Name (Legal Business Name): SYDEARIA SHAYLEE BOURIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2026
Last Update Date: 06/30/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 20TH ST N
BIRMINGHAM AL
35203-3644
US

IV. Provider business mailing address

2601 NEW ORLEANS ST SW
HUNTSVILLE AL
35805-4281
US

V. Phone/Fax

Practice location:
  • Phone: 855-832-6727
  • Fax: 772-675-9100
Mailing address:
  • Phone: 855-832-6727
  • Fax: 855-832-6727

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: