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General NPI Number Information
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NPI Number | 1588174189
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Entity Type | Individual
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Provider Name | SHAWNA RAE MIEHE BCABA, LABA
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Gender | Female
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Dates
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Enumeration Date | 10/09/2017
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Last Update Date | 10/09/2017
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Provider Practice Location Address
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Address Line | 638 INDEPENDENCE PKWY
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City | CHESAPEAKE
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State | VA
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Zip | 23320-5216
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Country | US
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Telephone | 757-276-9800
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Fax |
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Provider Business Mailing Address
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Address Line | 9625 CAPEVIEW AVE
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City | NORFOLK
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State | VA
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Zip | 23503-2601
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Country | US
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Telephone | 720-409-2112
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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 | 0134000182
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License Number State | VA
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