Provider Demographics
NPI:1558605352
Name:SHAFFER, AYSA (MS, BCBA)
Entity Type:Individual
Prefix:
First Name:AYSA
Middle Name:
Last Name:SHAFFER
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:AYSA
Other - Middle Name:
Other - Last Name:BADMAEVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1909 PELHAM AVE UNIT 104
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-5842
Mailing Address - Country:US
Mailing Address - Phone:805-291-2130
Mailing Address - Fax:
Practice Address - Street 1:1909 PELHAM AVE UNIT 104
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-5842
Practice Address - Country:US
Practice Address - Phone:805-291-2130
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-16
Last Update Date:2012-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-12-12189103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst