Healthcare Provider Details

I. General information

NPI: 1740118827
Provider Name (Legal Business Name): SHAYLA LYNNE BOGGA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2026
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

129 GRAHAM ST
DAYTON TN
37321-2151
US

IV. Provider business mailing address

129 GRAHAM ST
DAYTON TN
37321-2151
US

V. Phone/Fax

Practice location:
  • Phone: 541-314-2892
  • Fax:
Mailing address:
  • Phone: 541-314-2892
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: