Healthcare Provider Details

I. General information

NPI: 1639835705
Provider Name (Legal Business Name): SUNSHINE ABA THERAPY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/12/2021
Last Update Date: 11/12/2021
Certification Date: 11/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 ONYX DR
GREENBRIER AR
72058-9148
US

IV. Provider business mailing address

30 ONYX DR
GREENBRIER AR
72058-9148
US

V. Phone/Fax

Practice location:
  • Phone: 501-697-1768
  • Fax:
Mailing address:
  • Phone: 501-697-1768
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: MRS. SHARADY RENEE RICHARDSON
Title or Position: OWNER, BCBA
Credential: M.S., BCBA
Phone: 501-697-1768