Provider Demographics
NPI:1083806905
Name:KUNNAVATANA, SORAYA SHANUN (PHD, BCBA-D)
Entity Type:Individual
Prefix:
First Name:SORAYA
Middle Name:SHANUN
Last Name:KUNNAVATANA
Suffix:
Gender:F
Credentials:PHD, BCBA-D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:314 CHAPANOKE RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27603-3400
Mailing Address - Country:US
Mailing Address - Phone:919-773-2020
Mailing Address - Fax:919-773-1044
Practice Address - Street 1:314 CHAPANOKE RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27603-3400
Practice Address - Country:US
Practice Address - Phone:919-773-2020
Practice Address - Fax:919-773-1044
Is Sole Proprietor?:No
Enumeration Date:2007-08-14
Last Update Date:2019-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NC1-12-10045103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program