Healthcare Provider Details

I. General information

NPI: 1013820984
Provider Name (Legal Business Name): AMYIA SHUNTE HASBERRY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

359 TOWNE CENTER BLVD
RIDGELAND MS
39157-4868
US

IV. Provider business mailing address

2840 ROBINSON ST APT 210
JACKSON MS
39209-6823
US

V. Phone/Fax

Practice location:
  • Phone: 601-764-7718
  • Fax:
Mailing address:
  • Phone: 601-764-7718
  • Fax:

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: