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NPI Code Detail

MEDICARE: SHAHEEM LILLY

MEDICARE: SHAHEEM LILLY
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
1106S00000XBehavior TechnicianTX

General Provider Information

NPI Number : 1457217036
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHAHEEM LILLY
Provider Business Mailing Address
First Line : 8600 N FM 620 RD APT 1022
Second Line :
City : AUSTIN
State : TX
Zip : 78726-3536
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3300 N INTERSTATE 35 STE 700
Second Line :
City : AUSTIN
State : TX
Zip : 78705-1874
Country : US
Telephone Number : 512-967-4795
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/29/2025
Last Update Date : 12/29/2025

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Directions to “ SHAHEEM LILLY ” Practice Location

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