Provider Demographics
NPI:1518550383
Name:WALKER, SHAWN TERREL
Entity Type:Individual
Prefix:
First Name:SHAWN
Middle Name:TERREL
Last Name:WALKER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1089 TYSON AVE APT B
Mailing Address - Street 2:
Mailing Address - City:ABINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:19001-4415
Mailing Address - Country:US
Mailing Address - Phone:267-770-1542
Mailing Address - Fax:
Practice Address - Street 1:1089 TYSON AVE APT B
Practice Address - Street 2:
Practice Address - City:ABINGTON
Practice Address - State:PA
Practice Address - Zip Code:19001-4415
Practice Address - Country:US
Practice Address - Phone:267-770-1542
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-12
Last Update Date:2021-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty