Healthcare Provider Details

I. General information

NPI: 1841060910
Provider Name (Legal Business Name): SHANTIA MONIQUE SHEARS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2024
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8601 SIX FORKS RD STE 400
RALEIGH NC
27615-2965
US

IV. Provider business mailing address

111 MACKENAN DR
CARY NC
27511-7903
US

V. Phone/Fax

Practice location:
  • Phone: 919-329-1730
  • Fax:
Mailing address:
  • Phone: 919-371-2848
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number4776
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: