Provider Demographics
NPI:1467292524
Name:SHAMIS, BIANNA (MS, ABA, BCBA, LBA)
Entity type:Individual
Prefix:
First Name:BIANNA
Middle Name:
Last Name:SHAMIS
Suffix:
Gender:F
Credentials:MS, ABA, BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2421 OCEAN AVE APT 2B
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-3523
Mailing Address - Country:US
Mailing Address - Phone:718-496-0654
Mailing Address - Fax:
Practice Address - Street 1:2959 AVENUE Y
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-1624
Practice Address - Country:US
Practice Address - Phone:866-352-5010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-28
Last Update Date:2024-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003501103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst