Healthcare Provider Details

I. General information

NPI: 1770977282
Provider Name (Legal Business Name): SHAYLA ELLIS M.ED., BCBA, LBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2015
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3098 PIEDMONT RD NE STE 200
ATLANTA GA
30305-2600
US

IV. Provider business mailing address

542 AMHERST ST STE B
NASHUA NH
03063-1016
US

V. Phone/Fax

Practice location:
  • Phone: 561-850-7812
  • Fax:
Mailing address:
  • Phone: 561-850-7812
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number4776
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberLBA002965
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: