NPI 1972062495 · live from the CMS NPI Registry
Shane Jordan
Behavior Analyst in Vienna, VA. National Provider Identifier 1972062495, active.
NPI record
| NPI | 1972062495 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Behavior Analyst 103K00000X |
| Practice location | 8230 Leesburg Pike Ste 740, Vienna, VA 22182 |
| Practice phone | 877-504-4141 |
| Mailing address | 1325 S State St, Dover, DE 19901 |
| Enumerated | March 14, 2019 |
| Last updated | October 12, 2024 |
| Sole proprietor | No |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Behavior Analyst primary | 103K00000X | 1-23-66606 |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.