MEDICARE: SHAYLA DUDA 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
1	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1700443868
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAYLA DUDA BCBA

Provider Business Mailing Address
First Line	:	1848 9TH ST
Second Line	:
City	:	ALAMEDA
State	:	CA
Zip	:	94501-2224
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	11501 DUBLIN BLVD
Second Line	:
City	:	DUBLIN
State	:	CA
Zip	:	94568-2826
Country	:	US
Telephone Number	:	415-246-7901
Fax Number	:

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

Provider Enumeration Date	:	05/23/2019
Last Update Date	:	08/19/2019

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