Healthcare Provider Details

I. General information

NPI: 1245142041
Provider Name (Legal Business Name): SHAQUILLE ROBINSON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2026
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1234 HYDE PARK AVE
HYDE PARK MA
02136-2819
US

IV. Provider business mailing address

29 RAYNOR CIR
ROXBURY MA
02120-2406
US

V. Phone/Fax

Practice location:
  • Phone: 888-763-7272
  • Fax: 877-243-2959
Mailing address:
  • Phone: 888-763-7272
  • Fax: 877-243-2959

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: