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General NPI Number Information
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NPI Number | 1669250171
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Entity Type | Individual
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Provider Name | SHANTEE NICOLE BARICANOSA GARDE
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Gender | Female
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Dates
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Enumeration Date | 09/18/2023
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Last Update Date | 09/18/2023
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Provider Practice Location Address
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Address Line | 9030 RED BRANCH RD STE 100
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City | COLUMBIA
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State | MD
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Zip | 21045-2003
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Country | US
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Telephone | 410-630-7140
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Fax |
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Provider Business Mailing Address
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Address Line | 10040 CENTURY DR
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City | ELLICOTT CITY
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State | MD
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Zip | 21042-6248
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Country | US
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Telephone | 415-400-9359
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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 |
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License Number State |
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