MEDICARE: SHELBY REGENA DUNAGAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106E00000X	Assistant Behavior Analyst	BCABA-17-9537-082580	AL

General Provider Information

NPI Number	:	1083120315
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHELBY REGENA DUNAGAN

Provider Business Mailing Address
First Line	:	3296 CAHABA HEIGHTS RD # 200
Second Line	:
City	:	VESTAVIA
State	:	AL
Zip	:	35243-1653
Country	:	US
Telephone Number	:	205-253-6903
Fax Number	:

Provider Business Practice Location Address
First Line	:	3296 CAHABA HEIGHTS RD # 200
Second Line	:
City	:	VESTAVIA
State	:	AL
Zip	:	35243-1653
Country	:	US
Telephone Number	:	205-253-6903
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/22/2017
Last Update Date	:	12/22/2017

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