Healthcare Provider Details

I. General information

NPI: 1366790701
Provider Name (Legal Business Name): SHAWN PATRICK QUIGLEY SR. PH.D BCBA-D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2012
Last Update Date: 01/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 SIERRA NORTE LOOP NE
RIO RANCHO NM
87144-2514
US

IV. Provider business mailing address

1900 SIERRA NORTE LOOP NE
RIO RANCHO NM
87144-2514
US

V. Phone/Fax

Practice location:
  • Phone: 208-760-7346
  • Fax:
Mailing address:
  • Phone: 208-760-7346
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: