Healthcare Provider Details

I. General information

NPI: 1205456415
Provider Name (Legal Business Name): SHEYNA A MOORE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2020
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

631 RIVER OAKS PKWY
SAN JOSE CA
95134-1907
US

IV. Provider business mailing address

3459 KOHLER RD
SAN JOSE CA
95148-1727
US

V. Phone/Fax

Practice location:
  • Phone: 408-914-9153
  • Fax: 844-845-1117
Mailing address:
  • Phone: 408-914-9153
  • Fax: 844-845-1117

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: