Provider Demographics
NPI:1689236150
Name:SHAH, MAITRI (BCBA)
Entity Type:Individual
Prefix:MRS
First Name:MAITRI
Middle Name:
Last Name:SHAH
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 1:4430 TUMBLING LEAF CT
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-6885
Mailing Address - Country:US
Mailing Address - Phone:281-240-1649
Mailing Address - Fax:
Practice Address - Street 1:4430 TUMBLING LEAF CT
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-6885
Practice Address - Country:US
Practice Address - Phone:281-240-1649
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-03
Last Update Date:2022-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251S00000X
TX2880103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No251S00000XAgenciesCommunity/Behavioral Health