MEDICARE: SHAWN C WARREN

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	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1659118164
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAWN C WARREN

Provider Business Mailing Address
First Line	:	1063 YATES RD
Second Line	:
City	:	WALNUT COVE
State	:	NC
Zip	:	27052-6583
Country	:	US
Telephone Number	:	609-289-3816
Fax Number	:

Provider Business Practice Location Address
First Line	:	8311 BRIER CREEK PKWY STE 105-501
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27617-7328
Country	:	US
Telephone Number	:	787-833-6560
Fax Number	:

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

Provider Enumeration Date	:	07/11/2024
Last Update Date	:	07/11/2024

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