Provider Demographics
NPI:1316305840
Name:MATHEWS, SHANEKA NICHOLE (BCBA)
Entity type:Individual
Prefix:MRS
First Name:SHANEKA
Middle Name:NICHOLE
Last Name:MATHEWS
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2375
Mailing Address - Street 2:
Mailing Address - City:MOULTRIE
Mailing Address - State:GA
Mailing Address - Zip Code:31776-2375
Mailing Address - Country:US
Mailing Address - Phone:941-720-3273
Mailing Address - Fax:
Practice Address - Street 1:315 5TH AVE SE
Practice Address - Street 2:
Practice Address - City:MOULTRIE
Practice Address - State:GA
Practice Address - Zip Code:31768-4728
Practice Address - Country:US
Practice Address - Phone:941-720-3273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-28
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst