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NPI Code Detail

MEDICARE: SHAUNEYAH NICHOLS

MEDICARE: SHAUNEYAH NICHOLS
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 : 1992505671
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHAUNEYAH NICHOLS
Provider Business Mailing Address
First Line : 27777 INKSTER RD
Second Line :
City : FARMINGTON HILLS
State : MI
Zip : 48334-5310
Country : US
Telephone Number : 248-436-6561
Fax Number :
Provider Business Practice Location Address
First Line : 1410 CUSTER AVE SE
Second Line :
City : ATLANTA
State : GA
Zip : 30316-3304
Country : US
Telephone Number : 404-902-3744
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/13/2025
Last Update Date : 11/18/2025

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Directions to “ SHAUNEYAH NICHOLS ” Practice Location

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