Healthcare Provider Details

I. General information

NPI: 1164298667
Provider Name (Legal Business Name): ALLAZAE SHANTE HAYLEY RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/27/2023
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3700 PARK 42 DR STE 105
SHARONVILLE OH
45241-2083
US

IV. Provider business mailing address

2 VILLAGE SQ STE 210
BALTIMORE MD
21210-1624
US

V. Phone/Fax

Practice location:
  • Phone: 513-861-0300
  • Fax: 513-861-0213
Mailing address:
  • Phone: 513-861-0300
  • Fax: 513-861-0213

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-23-305283
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: