Healthcare Provider Details

I. General information

NPI: 1104408244
Provider Name (Legal Business Name): SHAMAR-TAJAI CLAUDE DOYLEY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2021
Last Update Date: 10/06/2025
Certification Date: 10/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2520 CORAL WAY STE 2-19
MIAMI FL
33145-3438
US

IV. Provider business mailing address

16201 NE 13TH AVE
NORTH MIAMI BEACH FL
33162-4607
US

V. Phone/Fax

Practice location:
  • Phone: 305-508-5580
  • Fax:
Mailing address:
  • Phone: 786-955-6224
  • Fax: 786-364-7244

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-25-84140
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberBACB673949
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: