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General NPI Number Information
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NPI Number | 1497682967
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Entity Type | Individual
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Provider Name | SHAWNTAE EUGINA MOSBY
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Gender | Female
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Dates
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Enumeration Date | 05/07/2026
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Last Update Date | 05/07/2026
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Provider Practice Location Address
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Address Line | 5164 E 81ST AVE
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City | MERRILLVILLE
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State | IN
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Zip | 46410-5852
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Country | US
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Telephone | 855-832-6727
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Fax |
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Provider Business Mailing Address
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Address Line | 11389 W 325 S
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City | RENSSELAER
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State | IN
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Zip | 47978-8822
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Country | US
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Telephone | 219-204-9910
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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 | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | RBT-26-528041
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License Number State | IN
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