Emily Shade

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

License

1-16-24304 Issued in CO

Practice address

1330 Quail Lake Loop
Suite 120
Colorado Springs, CO 80906-4651

Phone

(855) 223-7123

Fax

(619) 374-7134

NPI assigned

Oct 29, 2014

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

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": "1414540800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1512691200000",
    "number": "1750786000",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16782 VON KARMAN AVE STE 11",
            "city": "IRVINE",
            "state": "CA",
            "postal_code": "926062417",
            "telephone_number": "855-223-7123",
            "fax_number": "619-374-7134"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1330 QUAIL LAKE LOOP",
            "address_2": "SUITE 120",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809064651",
            "telephone_number": "855-223-7123",
            "fax_number": "619-374-7134"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1330 Quail Lake Loop",
            "address_2": "Suite 120",
            "address_purpose": "LOCATION",
            "city": "Colorado Springs",
            "state": "CO",
            "postal_code": "809064651",
            "country_code": "US",
            "telephone_number": "719-924-4533",
            "fax_number": "719-576-0089",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHADE",
        "first_name": "EMILY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-10-29",
        "last_updated": "2017-12-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106E00000X",
            "taxonomy_group": "",
            "desc": "Assistant Behavior Analyst",
            "state": "CO",
            "license": "0-14-6129",
            "primary": false
        },
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "CO",
            "license": "1-16-24304",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nicole Seyller, DNP, APRN, ACCNS-AG
• Skye Seymour
• Hunter Shackelton
• Olivya Shackelton
• Dariush Shackiba, P.T.
• Shadow Mountain Behavioral Health LLC.
• Shadow Mountain LLC.
• Shadow Mountain LLC.
• Shadow Mountain Recovery
• Douglas R Shaeffer, MD

• All providers in Colorado Springs, CO
• Behavior Analyst in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2017; 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.