Active NPI
Nicole Danielle Shaw, MS, NCC, LBS
- Behavior Analyst
- State College, PA
National Provider Identifier
1356989966
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Analyst
- License
- 004571
- Practice address
- 1400 Fox Hill Rd Ste 100
State College, PA 16803-1877 - Phone
- (814) 238-4851
- NPI assigned
- Dec 13, 2019
- 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 Analyst | 103K00000X | 004571 | PA | Primary |
Addresses
Primary practice location
1400 Fox Hill Rd Ste 100
State College, PA 16803-1877
Mailing address
14Oo Foxhill Road Suite 100
State College, PA 16803
Phone (814) 238-4851
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
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 004571 | PA | MD | Behavioral Analyst |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1576195200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1576195200000",
"number": "1356989966",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "14OO FOXHILL ROAD SUITE 100",
"city": "STATE COLLEGE",
"state": "PA",
"postal_code": "16803",
"telephone_number": "814-238-4851"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1400 FOX HILL RD STE 100",
"city": "STATE COLLEGE",
"state": "PA",
"postal_code": "168031877",
"telephone_number": "814-238-4851"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHAW",
"first_name": "NICOLE",
"middle_name": "DANIELLE",
"credential": "MS, NCC, LBS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-12-13",
"last_updated": "2019-12-13",
"certification_date": "2019-12-13",
"status": "A"
},
"taxonomies": [
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": "PA",
"license": "004571",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in State College, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 13, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.