Healthcare Provider Details

I. General information

NPI: 1518895192
Provider Name (Legal Business Name): DASIA BLACKSHEAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2026
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 FAIRWAY DR
DEERFIELD BEACH FL
33441-1834
US

IV. Provider business mailing address

33 ECKINGTON ST
SPRINGFIELD MA
01108-2836
US

V. Phone/Fax

Practice location:
  • Phone: 877-418-2978
  • Fax:
Mailing address:
  • Phone: 877-418-2878
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: