Provider Demographics
NPI:1235813536
Name:MANNAN, SHAHANA (BCABA)
Entity Type:Individual
Prefix:
First Name:SHAHANA
Middle Name:
Last Name:MANNAN
Suffix:
Gender:F
Credentials:BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:299 SAINT MARKS PL APT 510
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10301-1835
Mailing Address - Country:US
Mailing Address - Phone:347-741-4133
Mailing Address - Fax:
Practice Address - Street 1:299 SAINT MARKS PL APT 510
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10301-1835
Practice Address - Country:US
Practice Address - Phone:347-741-4133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-15
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000043103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst