Healthcare Provider Details

I. General information

NPI: 1992176887
Provider Name (Legal Business Name): SHANDRA ROSS RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2015
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10220 PROSPERITY PARK DR STE 300
CHARLOTTE NC
28269-1106
US

IV. Provider business mailing address

10220 PROSPERITY PARK DR STE 300
CHARLOTTE NC
28269-1106
US

V. Phone/Fax

Practice location:
  • Phone: 912-228-5621
  • Fax:
Mailing address:
  • Phone: 912-228-5621
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-24-323094
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: