MEDICARE: INTEGRATED AUTISM BEHAVIOR SERVICES LLC

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	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1144951351
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTEGRATED AUTISM BEHAVIOR SERVICES LLC

Provider Business Mailing Address
First Line	:	1110 HERNDON PKWY STE 305
Second Line	:
City	:	HERNDON
State	:	VA
Zip	:	20170-5547
Country	:	US
Telephone Number	:	703-943-6560
Fax Number	:	571-526-5550

Provider Business Practice Location Address
First Line	:	1110 HERNDON PKWY STE 305
Second Line	:
City	:	HERNDON
State	:	VA
Zip	:	20170-5547
Country	:	US
Telephone Number	:	703-943-6560
Fax Number	:	571-685-2221

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. FAZLUL KHALEQ SHUJA
Credential	:	MEDICAL DOCTOR
Telephone Number	:	202-340-6334

Provider Enumeration Date	:	06/19/2022
Last Update Date	:	08/20/2025

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