MEDICARE: SHEENAH GILL 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	1-16-24313	CA
2	106E00000X	Assistant Behavior Analyst	0-16-7366	CA

General Provider Information

NPI Number	:	1861942815
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHEENAH GILL BCBA

Provider Business Mailing Address
First Line	:	1431 PACIFIC HWY UNIT 714
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92101-8328
Country	:	US
Telephone Number	:	858-354-9677
Fax Number	:

Provider Business Practice Location Address
First Line	:	1431 PACIFIC HWY UNIT 714
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92101-8328
Country	:	US
Telephone Number	:	858-354-9677
Fax Number	:

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

Provider Enumeration Date	:	10/13/2016
Last Update Date	:	10/27/2020

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