Provider Demographics
NPI:1609555473
Name:CARTY, SHAELYNN RAE
Entity Type:Individual
Prefix:
First Name:SHAELYNN
Middle Name:RAE
Last Name:CARTY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18504 W COLLEGE DR
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85395-2690
Mailing Address - Country:US
Mailing Address - Phone:480-231-9141
Mailing Address - Fax:
Practice Address - Street 1:18504 W COLLEGE DR
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85395-2690
Practice Address - Country:US
Practice Address - Phone:480-231-9141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-17
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst