1083806905 NPI number — SORAYA SHANUN KUNNAVATANA PHD., BCBA-D

Table of content: SORAYA SHANUN KUNNAVATANA PHD., BCBA-D (NPI 1083806905)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083806905 NPI number — SORAYA SHANUN KUNNAVATANA PHD., BCBA-D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KUNNAVATANA
Provider First Name:
SORAYA
Provider Middle Name:
SHANUN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PHD., BCBA-D
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1083806905
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/04/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
314 CHAPANOKE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RALEIGH
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27603-3400
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-773-2020
Provider Business Mailing Address Fax Number:
919-773-1044

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
314 CHAPANOKE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RALEIGH
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27603-3400
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-773-2020
Provider Business Practice Location Address Fax Number:
919-773-1044
Provider Enumeration Date:
08/14/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103K00000X , with the licence number: 1-12-10045 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com