1760052708 NPI number — BRITTANY ANN SHINN BCBA

Table of content: BRITTANY ANN SHINN BCBA (NPI 1760052708)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760052708 NPI number — BRITTANY ANN SHINN BCBA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHINN
Provider First Name:
BRITTANY
Provider Middle Name:
ANN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
BCBA
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:
1760052708
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/18/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
90 WHITE PINE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLTS NECK
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07722-1531
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
609-361-4402
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1001 BRIGGS RD STE 280
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOUNT LAUREL
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08054-4104
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
609-361-4402
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/01/2021

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: 103K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: YKT3HZN07370050 . This is a "HORIZON BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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