Shea Sample, BCBA

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

Practice address

77 W Baltimore Pike Ste 100B
Media, PA 19063-5639

Phone

(610) 957-0143

NPI assigned

Dec 18, 2020

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1608249600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1738540800000",
    "number": "1477149995",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "77 W BALTIMORE PIKE STE 100B",
            "city": "MEDIA",
            "state": "PA",
            "postal_code": "190635639",
            "telephone_number": "484-965-9966"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "77 W BALTIMORE PIKE STE 100B",
            "city": "MEDIA",
            "state": "PA",
            "postal_code": "190635639",
            "telephone_number": "610-957-0143"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "209 W Lancaster Ave",
            "address_purpose": "LOCATION",
            "city": "Paoli",
            "state": "PA",
            "postal_code": "193011749",
            "country_code": "US",
            "telephone_number": "484-965-9966",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1646 W Chester Pike Ste 4",
            "address_purpose": "LOCATION",
            "city": "West Chester",
            "state": "PA",
            "postal_code": "193827979",
            "country_code": "US",
            "telephone_number": "610-957-0143",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SAMPLE",
        "first_name": "SHEA",
        "credential": "BCBA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-12-18",
        "last_updated": "2025-02-03",
        "certification_date": "2025-02-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Behavior Analyst in Media, PA
• Providers in Media, PA by specialty
• Behavior Analyst in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.