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1043702905 NPI number — STACEY RENEE SHINN BCBA

NPI Number: 1043702905
Health Care Provider/Practitioner: STACEY RENEE SHINN BCBA

Information about “1043702905” NPI (STACEY RENEE SHINN BCBA) exists in 1043702905 in HTML format HTML  |  1043702905 in plain Text format TXT  |  1043702905 in PDF (Portable Document Format) PDF  |  1043702905 in an XML format XML  formats.

NPI Number : 1043702905 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1043702905",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "SHINN",
    "FirstName": "STACEY",
    "MiddleName": "RENEE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "BCBA",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "STENGER",
    "OtherFirstName": "STACEY",
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "5",
    "FirstLineMailingAddress": "3300 AIRPORT RD TRLR G18",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "ALAMOGORDO",
    "MailingAddressStateName": "NM",
    "MailingAddressPostalCode": "88310-8116",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "812-528-0975",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "500 ALA MOANA BLVD STE 7400",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "HONOLULU",
    "PracticeLocationAddressStateName": "HI",
    "PracticeLocationAddressPostalCode": "96813-4902",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "808-501-1300",
    "PracticeLocationAddressFaxNumber": "855-892-0299",
    "EnumerationDate": "06/05/2018",
    "LastUpdateDate": "04/16/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "103K00000X",
          "TaxonomyName": "Behavior Analyst",
          "LicenseNumber": "BA60982073",
          "LicenseNumberStateCode": "WA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "103K00000X",
          "TaxonomyName": "Behavior Analyst",
          "LicenseNumber": "BA-937",
          "LicenseNumberStateCode": "HI",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "103K00000X",
          "TaxonomyName": "Behavior Analyst",
          "LicenseNumber": "1-16-21977",
          "LicenseNumberStateCode": "WA",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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