Healthcare Provider Details

I. General information

NPI: 1700385127
Provider Name (Legal Business Name): SEWRA CUDDUS BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/12/2018
Last Update Date: 11/09/2021
Certification Date: 11/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12406 SKYVIEW CRESCENT CT
HOUSTON TX
77047-1406
US

IV. Provider business mailing address

12406 SKYVIEW CRESCENT CT
HOUSTON TX
77047-1406
US

V. Phone/Fax

Practice location:
  • Phone: 832-303-8208
  • Fax:
Mailing address:
  • Phone: 832-303-8208
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-17-28080
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: