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General NPI Number Information
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NPI Number | 1215409156
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Entity Type | Individual
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Provider Name | JEANNETTE CAZARES SHOOSHTARI
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Gender | Female
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Dates
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Enumeration Date | 12/17/2018
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Last Update Date | 04/23/2025
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Provider Practice Location Address
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Address Line | 3660 WHEELER AVE STE A
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City | ALEXANDRIA
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State | VA
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Zip | 22304-6403
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Country | US
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Telephone | 703-870-3380
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Fax |
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Provider Business Mailing Address
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Address Line | 2423 S ORANGE AVE # 353
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City | ORLANDO
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State | FL
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Zip | 32806-4543
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Country | US
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Telephone | 703-870-3880
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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 | 0133002136
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License Number State | VA
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