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NPI Code Detail

MEDICARE: SHELBY DANIEL BCBA

MEDICARE: SHELBY DANIEL BCBA
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
1103K00000XBehavior Analyst

General Provider Information

NPI Number : 1548115611
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHELBY DANIEL BCBA
Provider Business Mailing Address
First Line : 2417 PRESIDIO VISTA DR
Second Line :
City : FORT WORTH
State : TX
Zip : 76177-8275
Country : US
Telephone Number : 682-227-2757
Fax Number :
Provider Business Practice Location Address
First Line : 2417 PRESIDIO VISTA DR
Second Line :
City : FORT WORTH
State : TX
Zip : 76177-8275
Country : US
Telephone Number : 682-227-2757
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/03/2026
Last Update Date : 03/03/2026

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