Active NPI
Dalisha Quanae Ellis
- Behavior Technician
- Stockbridge, GA
National Provider Identifier
1245929181
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- Practice address
- 115 N Park TRL Ste 123
Stockbridge, GA 30281-7373 - Phone
- (470) 491-2050
- NPI assigned
- May 5, 2023
- Reactivated
- Jun 6, 2023
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | Primary |
Addresses
Primary practice location
115 N Park TRL Ste 123
Stockbridge, GA 30281-7373
Mailing address
300 International Parkway
Suite 200
Lake Mary, FL 32746-3625
Phone (866) 610-0580
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1683244800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1686009600000",
"number": "1245929181",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "300 INTERNATIONAL PARKWAY",
"address_2": "SUITE 200",
"city": "LAKE MARY",
"state": "FL",
"postal_code": "327463625",
"telephone_number": "866-610-0580"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "115 N PARK TRL STE 123",
"city": "STOCKBRIDGE",
"state": "GA",
"postal_code": "302817373",
"telephone_number": "470-491-2050"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ELLIS",
"first_name": "DALISHA",
"middle_name": "QUANAE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-05-05",
"last_updated": "2023-06-06",
"certification_date": "2023-06-06",
"deactivation_date": "2023-05-14",
"reactivation_date": "2023-06-06",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Stockbridge, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.