=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447992631
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DANIA MELODY SHIEKH
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/08/2022
-----------------------------------------------------
Last Update Date | 04/08/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3050 SATURN ST STE 102
-----------------------------------------------------
City | BREA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92821-6281
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 657-444-9002
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2 HIGO ST
-----------------------------------------------------
City | RANCHO MISSION VIEJO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92694-1288
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-888-8118
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106S00000X
-----------------------------------------------------
Taxonomy Name | Behavior Technician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------