Provider Demographics
NPI:1497146997
Name:PEIKARI, SHAHAB SEAN (BCBA)
Entity Type:Individual
Prefix:MR
First Name:SHAHAB
Middle Name:SEAN
Last Name:PEIKARI
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9927 WETHERS FIELD CIR
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE VILLAGE
Mailing Address - State:TX
Mailing Address - Zip Code:76227-8590
Mailing Address - Country:US
Mailing Address - Phone:469-441-7099
Mailing Address - Fax:
Practice Address - Street 1:2815 EXCHANGE BLVD STE 100
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-7515
Practice Address - Country:US
Practice Address - Phone:516-510-1205
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-05
Last Update Date:2021-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-17-28634103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1-17-28634OtherBACB CERTIFICATION NUMBER