Healthcare Provider Details

I. General information

NPI: 1124905716
Provider Name (Legal Business Name): SHANIA GAIL MEJIA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2025
Last Update Date: 08/18/2025
Certification Date: 08/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

599 HIGHWAY 37 W STE 1
TOMS RIVER NJ
08755-8011
US

IV. Provider business mailing address

950 E HAVERFORD RD STE 100A
BRYN MAWR PA
19010-3850
US

V. Phone/Fax

Practice location:
  • Phone: 877-222-0399
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-25-83535
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: