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General NPI Number Information
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NPI Number | 1043702905
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Entity Type | Individual
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Provider Name | STACEY RENEE SHINN BCBA
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Gender | Female
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Dates
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Enumeration Date | 06/05/2018
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Last Update Date | 04/16/2025
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Provider Practice Location Address
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Address Line | 500 ALA MOANA BLVD STE 7400
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City | HONOLULU
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State | HI
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Zip | 96813-4902
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Country | US
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Telephone | 808-501-1300
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Fax | 855-892-0299
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Provider Business Mailing Address
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Address Line | 3300 AIRPORT RD TRLR G18
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City | ALAMOGORDO
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State | NM
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Zip | 88310-8116
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Country | US
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Telephone | 812-528-0975
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | BA60982073
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | BA-937
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License Number State | HI
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Taxonomy #3
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-16-21977
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License Number State | WA
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