MEDICARE: ACACIA SHIROMA

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		TX

General Provider Information

NPI Number	:	1225900012
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ACACIA SHIROMA

Provider Business Mailing Address
First Line	:	9137 SAINT KITTS RD
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76123-3523
Country	:	US
Telephone Number	:	682-206-8098
Fax Number	:

Provider Business Practice Location Address
First Line	:	9137 SAINT KITTS RD
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76123-3523
Country	:	US
Telephone Number	:	682-206-8098
Fax Number	:

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

Provider Enumeration Date	:	09/22/2025
Last Update Date	:	09/22/2025

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Directions to “ ACACIA SHIROMA ” Practice Location

Language	Start Address	Practice Location

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