Healthcare Provider Details

I. General information

NPI: 1700372893
Provider Name (Legal Business Name): MEERA SHAH M.ED, BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2018
Last Update Date: 09/18/2023
Certification Date: 09/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8809 W BRYN MAWR AVE STE 204
CHICAGO IL
60531-3524
US

IV. Provider business mailing address

8809 W BRYN MAWR AVE STE 204
CHICAGO IL
60531-3524
US

V. Phone/Fax

Practice location:
  • Phone: 773-644-7787
  • Fax:
Mailing address:
  • Phone: 773-644-7787
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-16-27554
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-19-34693
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: