Provider Demographics
NPI:1992241764
Name:STONE, SHANA
Entity type:Individual
Prefix:
First Name:SHANA
Middle Name:
Last Name:STONE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHANA
Other - Middle Name:F
Other - Last Name:BAHIC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4227 VEGAS DE SUENOS
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87507-2638
Mailing Address - Country:US
Mailing Address - Phone:505-603-0058
Mailing Address - Fax:
Practice Address - Street 1:4227 VEGAS DE SUENOS
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87507-2638
Practice Address - Country:US
Practice Address - Phone:505-603-0058
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-17
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician