Provider Demographics
NPI:1467179978
Name:SHEA, AMANDA (BCBA)
Entity Type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:
Last Name:SHEA
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11530 PINE TREE PL
Mailing Address - Street 2:
Mailing Address - City:STRONGSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44136-3620
Mailing Address - Country:US
Mailing Address - Phone:216-255-8798
Mailing Address - Fax:
Practice Address - Street 1:842 CORPORATE WAY STE 830
Practice Address - Street 2:
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-1569
Practice Address - Country:US
Practice Address - Phone:216-255-8798
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-25
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1-21-54927103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst