Healthcare Provider Details

I. General information

NPI: 1316874027
Provider Name (Legal Business Name): SHADE PICKARD
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

8810 BLONDO ST
OMAHA NE
68134-6116
US

IV. Provider business mailing address

307 N 31ST ST
OMAHA NE
68131-2905
US

V. Phone/Fax

Practice location:
  • Phone: 402-742-0311
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: