Individual provider Active NPI

Shelby Freitas, M.ED., BCBA

  • Behavior Analyst
  • Fresno, CA
National Provider Identifier
1588159297
Registry record updated Jun 25, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Behavior AnalystTaxonomy code 103K00000X
License
18-3788-108841 Issued in CA
Practice address
1630 E Shaw Ave Ste 190
Fresno, CA 93710-8114
Phone
(559) 475-7860
Fax
(559) 570-0222
NPI assigned
Jun 25, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 25, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Behavior Analyst 103K00000X 18-3788-108841 CA Primary

Addresses

Primary practice location

1630 E Shaw Ave Ste 190
Fresno, CA 93710-8114

Mailing address

5132 N Palm Ave
PMB 303
Fresno, CA 93704-2236
Phone (559) 475-7860

Other identifiers 1

IdentifierTypeStateIssuer
18-3788-108841OtherCABEHAVIOR ANALYSIS

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 Education

State licenses

LicenseStateTypeSpecialty
18-3788-108841CAMDBehavioral Analyst

NPI Registry JSON

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

{
    "created_epoch": "1529884800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1529884800000",
    "number": "1588159297",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5132 N PALM AVE",
            "address_2": "PMB 303",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937042236",
            "telephone_number": "559-475-7860",
            "fax_number": "559-570-0222"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1630 E SHAW AVE STE 190",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937108114",
            "telephone_number": "559-475-7860",
            "fax_number": "559-570-0222"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FREITAS",
        "first_name": "SHELBY",
        "credential": "M.ED., BCBA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-06-25",
        "last_updated": "2018-06-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "CA",
            "license": "18-3788-108841",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BEHAVIOR ANALYSIS",
            "identifier": "18-3788-108841",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fresno, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2018; 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.