Provider Demographics
NPI:1477953347
Name:SKARDA, SHONNA (MA, CALT, LDT)
Entity Type:Individual
Prefix:
First Name:SHONNA
Middle Name:
Last Name:SKARDA
Suffix:
Gender:F
Credentials:MA, CALT, LDT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12591 RESEARCH BLVD
Mailing Address - Street 2:STE 201
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-2248
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12591 RESEARCH BLVD
Practice Address - Street 2:STE 201
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-2248
Practice Address - Country:US
Practice Address - Phone:512-497-5638
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-28
Last Update Date:2014-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2094174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist