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General NPI Number Information
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NPI Number | 1669701637
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Entity Type | Individual
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Provider Name | KIMBERLY ANN SHAHARIYAR
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Gender | Female
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Dates
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Enumeration Date | 12/21/2009
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Last Update Date | 01/20/2022
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Provider Practice Location Address
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Address Line | 9500 LAKEVIEW PKWY STE 200
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City | ROWLETT
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State | TX
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Zip | 75088-4560
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Country | US
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Telephone | 469-469-9021
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Fax |
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Provider Business Mailing Address
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Address Line | 1709 ARROW LN
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City | GARLAND
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State | TX
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Zip | 75042-8312
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Country | US
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Telephone | 469-900-7608
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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 | 1-21-47097
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License Number State | TX
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