Healthcare Provider Details

I. General information

NPI: 1699241513
Provider Name (Legal Business Name): NEURO PSYCHIATRIC & BEHAVIORAL REHABILITATION PRACTITIONERS ASSOCIATIO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2018
Last Update Date: 08/05/2022
Certification Date: 08/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

534 HUNT LN
SAN ANTONIO TX
78245-2333
US

IV. Provider business mailing address

534 HUNT LN
SAN ANTONIO TX
78245-2333
US

V. Phone/Fax

Practice location:
  • Phone: 210-606-2319
  • Fax:
Mailing address:
  • Phone: 210-606-2319
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084B0040X
TaxonomyBehavioral Neurology & Neuropsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. SHANEQUIA DESHAWN CLEMONS
Title or Position: NEUROPSYCH REHAB PRACTITIONER
Credential:
Phone: 281-826-0080