Healthcare Provider Details

I. General information

NPI: 1821811969
Provider Name (Legal Business Name): MAHMOUD IBRAHIM ALI SHEHATA SR. MS , BCBA , LBA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2024
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1411 COLLEGIATE CIR
RALEIGH NC
27606
US

IV. Provider business mailing address

1411 COLLEGIATE CIR
RALEIGH NC
27606-4663
US

V. Phone/Fax

Practice location:
  • Phone: 845-464-2798
  • Fax: 845-464-2798
Mailing address:
  • Phone: 845-464-2798
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-25-81161
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: