Healthcare Provider Details

I. General information

NPI: 1578473666
Provider Name (Legal Business Name): SHAMAR DAMEON RAPU PA, RBT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: SUHLOR DAMEON RAPU PA, RBT

II. Dates (important events)

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

III. Provider practice location address

2306 W MEADOWVIEW RD
GREENSBORO NC
27407-3758
US

IV. Provider business mailing address

208 WIND RD APT L
GREENSBORO NC
27405-2684
US

V. Phone/Fax

Practice location:
  • Phone: 516-206-8900
  • Fax:
Mailing address:
  • Phone: 516-206-8900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-26-534689
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: