Shape Behavior Solutions, LLC

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

Legal business name

SHAPE BEHAVIOR SOLUTIONS, LLC

Practice address

5534 Saint Joe Rd
Fort Wayne, IN 46835-3328

Phone

(630) 240-4437

NPI assigned

Dec 20, 2021

Organization subpart

No

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

Authorized official

Name

Christina M Imgrund, MA, BCBA, LBA

Title

Partner

Phone

(630) 240-4437

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1639958400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1645401600000",
    "number": "1558021485",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1389 W 86TH ST # 177",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462602101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5534 SAINT JOE RD",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468353328",
            "telephone_number": "630-240-4437"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHAPE BEHAVIOR SOLUTIONS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-12-20",
        "last_updated": "2022-02-21",
        "certification_date": "2022-02-21",
        "status": "A",
        "authorized_official_last_name": "IMGRUND",
        "authorized_official_first_name": "CHRISTINA",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "630-240-4437",
        "authorized_official_credential": "MA, BCBA, LBA"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Behavior Analyst",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ellen Dolores Shannon, MSED, LMHC
• Micah Shannon
• Patrick Dewayne Shannon
• Frank Shao, M.D.
• Michael Yuzhou Shao, MD
• Ahmed M Sharaan
• Amit Sharma, OTR
• Ashish Sharma, MD
• Sadikshya Sharma, MD
• Umesh Dutt Sharma

• Behavior Analyst in Fort Wayne, IN
• Providers in Fort Wayne, IN by specialty
• Behavior Analyst in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 21, 2022; 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.