Ethan Daniel Shuford

Primary specialty

Behavior TechnicianTaxonomy code 106S00000X

Practice address

100 Commerce CT
Pooler, GA 31322-9445

Phone

(615) 560-6622

NPI assigned

Dec 25, 2024

Sex

Male

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": "1735084800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1735084800000",
    "number": "1508674300",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "163 19TH AVE NW",
            "city": "HICKORY",
            "state": "NC",
            "postal_code": "286011830",
            "telephone_number": "828-261-6462"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 COMMERCE CT",
            "city": "POOLER",
            "state": "GA",
            "postal_code": "313229445",
            "telephone_number": "615-560-6622"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHUFORD",
        "first_name": "ETHAN",
        "middle_name": "DANIEL",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-12-25",
        "last_updated": "2024-12-25",
        "certification_date": "2024-12-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Helen Dawn Seymour
• Cameron Sharkins
• Keana Shaw
• Teri Ashlea Shoop
• Kerry Kathleen Shuffelbottom, PA-C
• Brandon Siaj, DMD
• Whitney Sigler, BT
• Mikaela Simmons
• Trickera T Sims, FNP-BC
• Charlotte Jeanne Singh

• Behavior Technician in Pooler, GA
• Providers in Pooler, GA by specialty
• Behavior Technician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 25, 2024; 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.