Provider Demographics
NPI:1124776539
Name:SHADE, SIERRA
Entity type:Individual
Prefix:
First Name:SIERRA
Middle Name:
Last Name:SHADE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:MISSION AUTISM CLINIC
Mailing Address - Street 2:560 VAN REED RD, SUITE 102
Mailing Address - City:WYOMISSING
Mailing Address - State:PA
Mailing Address - Zip Code:19610-1620
Mailing Address - Country:US
Mailing Address - Phone:888-726-4774
Mailing Address - Fax:
Practice Address - Street 1:1708 N 16TH ST
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19604-1620
Practice Address - Country:US
Practice Address - Phone:610-621-0065
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-15
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician