Healthcare Provider Details

I. General information

NPI: 1215594155
Provider Name (Legal Business Name): MEGAN ALEXIS SHAW BCBA, LABA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MEGAN ALEXIS VOZZELLA

II. Dates (important events)

Enumeration Date: 05/28/2019
Last Update Date: 01/01/2026
Certification Date: 01/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43 HILLSIDE VLG
WARE MA
01082-1184
US

IV. Provider business mailing address

43 HILLSIDE VLG
WARE MA
01082-1184
US

V. Phone/Fax

Practice location:
  • Phone: 413-325-7992
  • Fax:
Mailing address:
  • Phone: 413-325-7992
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number12583731
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: