Provider Demographics
NPI:1083415129
Name:STUBLESKI, SHIALOH JORDYN
Entity type:Individual
Prefix:
First Name:SHIALOH
Middle Name:JORDYN
Last Name:STUBLESKI
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2929 ALTAMESA BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76133-5711
Mailing Address - Country:US
Mailing Address - Phone:817-532-3302
Mailing Address - Fax:817-532-3302
Practice Address - Street 1:2929 ALTAMESA BLVD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76133-5711
Practice Address - Country:US
Practice Address - Phone:817-532-3302
Practice Address - Fax:817-532-3302
Is Sole Proprietor?:No
Enumeration Date:2025-03-24
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician