Shanetrea Anderson, RBT

Key facts

NPI

1043061328

Entity type

Individual (NPI type 1)

Primary specialty

Behavior Technician 106S00000X

License

RBT-24-335878 (GA)

Practice address

200 Brookstone Centre Pkwy BLDG 200
Columbus, GA 31904-4559

Phone

(762) 239-0017

Fax

(317) 520-8200

NPI assigned

Mar 27, 2024

Sex

Female

Sole proprietor

No

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

State licenses

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Mar 27, 2024.

{
    "created_epoch": "1711497600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1711497600000",
    "number": "1043061328",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3500 DEPAUW BLVD STE 3070",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462686135",
            "telephone_number": "855-324-0885",
            "fax_number": "317-520-8200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 BROOKSTONE CENTRE PKWY BLDG 200",
            "city": "COLUMBUS",
            "state": "GA",
            "postal_code": "319044559",
            "telephone_number": "762-239-0017",
            "fax_number": "317-520-8200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANDERSON",
        "first_name": "SHANETREA",
        "credential": "RBT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-03-27",
        "last_updated": "2024-03-27",
        "certification_date": "2024-03-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": "GA",
            "license": "RBT-24-335878",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Columbus, GA

• Mark Winthrop Anderson Jr., PHARM D
• Melissa Anderson, RBT
• Mindi M Anderson
• Peter E Anderson, MD
• Qamoriyon Anderson, RBT
• Sherry Lorraine Anderson, NURSE PRACTITIONER
• Tadaysheanna J Anderson, RBT
• Tamika Anderson
• Terri Anderson
• Terriana Anderson

All providers in Columbus, GA · Behavior Technician in Georgia