Healthcare Provider Details

I. General information

NPI: 1699540708
Provider Name (Legal Business Name): SHUBHAVI ARYA MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2023
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 NW 167TH PL STE 115
BEAVERTON OR
97006-4846
US

IV. Provider business mailing address

1355 NW EVERETT ST STE 100
PORTLAND OR
97209-2655
US

V. Phone/Fax

Practice location:
  • Phone: 855-772-8847
  • Fax:
Mailing address:
  • Phone: 503-610-3607
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberLBA.BA.70055662
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberABA-B-10261895
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: