Provider Demographics
NPI:1124422001
Name:AHUJA MEDURI, SHEELA (BCBA)
Entity type:Individual
Prefix:
First Name:SHEELA
Middle Name:
Last Name:AHUJA MEDURI
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:SHEELA
Other - Middle Name:AHUJA
Other - Last Name:MEDURI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BCBA
Mailing Address - Street 1:4598 DEVONSHIRE CMN
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94536-5760
Mailing Address - Country:US
Mailing Address - Phone:650-906-3389
Mailing Address - Fax:
Practice Address - Street 1:4598 DEVONSHIRE CMN
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94536-5760
Practice Address - Country:US
Practice Address - Phone:650-906-3389
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-21
Last Update Date:2014-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst