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General NPI Number Information
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NPI Number | 1164298667
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Entity Type | Individual
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Provider Name | ALLAZAE SHANTE HAYLEY RBT
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Gender | Female
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Dates
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Enumeration Date | 11/27/2023
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Last Update Date | 12/19/2025
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Provider Practice Location Address
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Address Line | 3700 PARK 42 DR STE 105
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City | SHARONVILLE
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State | OH
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Zip | 45241-2083
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Country | US
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Telephone | 513-861-0300
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Fax | 513-861-0213
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Provider Business Mailing Address
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Address Line | 2 VILLAGE SQ STE 210
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City | BALTIMORE
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State | MD
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Zip | 21210-1624
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Country | US
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Telephone | 513-861-0300
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Fax | 513-861-0213
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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 | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | RBT-23-305283
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License Number State | OH
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