Healthcare Provider Details

I. General information

NPI: 1659287142
Provider Name (Legal Business Name): SHANDA CHRISTINE FAULKENBURY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7108 S KANNER HWY
STUART FL
34997-7462
US

IV. Provider business mailing address

16670 E NEBRASKA AVE
REEDLEY CA
93654-9214
US

V. Phone/Fax

Practice location:
  • Phone: 916-931-3270
  • Fax:
Mailing address:
  • Phone: 559-305-0645
  • Fax: 559-305-0645

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License NumberD7832640
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: