Provider Demographics
NPI:1497266621
Name:PAUL, SHAUNA LEE (BCBA)
Entity Type:Individual
Prefix:
First Name:SHAUNA
Middle Name:LEE
Last Name:PAUL
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 1:75-217 NANI KAILUA DR APT 156
Mailing Address - Street 2:
Mailing Address - City:KAILUA KONA
Mailing Address - State:HI
Mailing Address - Zip Code:96740-2069
Mailing Address - Country:US
Mailing Address - Phone:575-642-0754
Mailing Address - Fax:
Practice Address - Street 1:75-217 NANI KAILUA DR APT 156
Practice Address - Street 2:
Practice Address - City:KAILUA KONA
Practice Address - State:HI
Practice Address - Zip Code:96740-2069
Practice Address - Country:US
Practice Address - Phone:575-642-0754
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-15
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
247200000X
HI1-21-55483103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other