MEDICARE: SHONDA ROBINSON

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	:	1396143921
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHONDA ROBINSON

Provider Business Mailing Address
First Line	:	3913 NW 23RD ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73107-2739
Country	:	US
Telephone Number	:	405-698-0778
Fax Number	:	405-602-0124

Provider Business Practice Location Address
First Line	:	3913 NW 23RD ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73107-2739
Country	:	US
Telephone Number	:	405-698-0778
Fax Number	:	405-602-0124

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

Provider Enumeration Date	:	12/13/2014
Last Update Date	:	12/13/2014

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Directions to “ SHONDA ROBINSON ” Practice Location

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