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General NPI Number Information
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NPI Number | 1568010999
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Entity Type | Individual
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Provider Name | SHAMS ISAM YALDO
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Gender | Female
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Dates
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Enumeration Date | 08/28/2019
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Last Update Date | 09/17/2024
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Provider Practice Location Address
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Address Line | 30503 GREENFIELD RD
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City | SOUTHFIELD
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State | MI
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Zip | 48076-1594
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Country | US
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Telephone | 248-691-4744
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Fax | 248-691-4745
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Provider Business Mailing Address
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Address Line | 26901 BEAUMONT BLVD # 3D
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City | SOUTHFIELD
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State | MI
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Zip | 48033-3849
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Country | US
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Telephone | 947-522-1952
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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 | 7401002338
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License Number State | MI
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