MEDICARE: MR. HUNTER SHAW

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		RI

General Provider Information

NPI Number	:	1164387478
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. HUNTER SHAW

Provider Business Mailing Address
First Line	:	38 PLANT ST
Second Line	:
City	:	CUMBERLAND
State	:	RI
Zip	:	02864-1911
Country	:	US
Telephone Number	:	401-585-8899
Fax Number	:

Provider Business Practice Location Address
First Line	:	38 PLANT ST
Second Line	:
City	:	CUMBERLAND
State	:	RI
Zip	:	02864-1911
Country	:	US
Telephone Number	:	401-585-8899
Fax Number	:

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

Provider Enumeration Date	:	12/18/2025
Last Update Date	:	12/18/2025

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