Healthcare Provider Details

I. General information

NPI: 1518606185
Provider Name (Legal Business Name): SHAIKIREA MALASIA GORDON BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2022
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

730 PEACHTREE ST NE
ATLANTA GA
30308-1210
US

IV. Provider business mailing address

730 PEACHTREE ST NE
ATLANTA GA
30308-1210
US

V. Phone/Fax

Practice location:
  • Phone: 404-551-5330
  • Fax: 404-689-3163
Mailing address:
  • Phone: 404-551-5330
  • Fax: 404-689-3163

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-2828067
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: