MEDICARE: MR. MAHMOUD IBRAHIM ALI SHEHATA SR. MS , BCBA , LBA

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	1-25-81161	NC

General Provider Information

NPI Number	:	1821811969
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MAHMOUD IBRAHIM ALI SHEHATA SR. MS , BCBA , LBA

Provider Business Mailing Address
First Line	:	1411 COLLEGIATE CIR
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27606-4663
Country	:	US
Telephone Number	:	845-464-2798
Fax Number	:

Provider Business Practice Location Address
First Line	:	1411 COLLEGIATE CIR
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27606
Country	:	US
Telephone Number	:	845-464-2798
Fax Number	:	845-464-2798

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

Provider Enumeration Date	:	11/06/2024
Last Update Date	:	05/27/2026

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