Provider Demographics
NPI:1083120315
Name:DUNAGAN, SHELBY REGENA
Entity Type:Individual
Prefix:
First Name:SHELBY
Middle Name:REGENA
Last Name:DUNAGAN
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 1:3296 CAHABA HEIGHTS RD # 200
Mailing Address - Street 2:
Mailing Address - City:VESTAVIA
Mailing Address - State:AL
Mailing Address - Zip Code:35243-1653
Mailing Address - Country:US
Mailing Address - Phone:205-253-6903
Mailing Address - Fax:
Practice Address - Street 1:3296 CAHABA HEIGHTS RD # 200
Practice Address - Street 2:
Practice Address - City:VESTAVIA
Practice Address - State:AL
Practice Address - Zip Code:35243-1653
Practice Address - Country:US
Practice Address - Phone:205-253-6903
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-22
Last Update Date:2017-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALBCABA-17-9537-082580106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst