MEDICARE: MS. SHAWANNA YVETTE WRAY

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	:	1285996371
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SHAWANNA YVETTE WRAY

Provider Business Mailing Address
First Line	:	5156 FLAY RD
Second Line	:
City	:	LINCOLNTON
State	:	NC
Zip	:	28092-0793
Country	:	US
Telephone Number	:	336-327-0959
Fax Number	:

Provider Business Practice Location Address
First Line	:	166 W FRANKLIN BLVD
Second Line	:
City	:	GASTONIA
State	:	NC
Zip	:	28052-4107
Country	:	US
Telephone Number	:	704-864-1001
Fax Number	:	704-864-6050

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

Provider Enumeration Date	:	06/13/2012
Last Update Date	:	06/13/2012

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