Provider Demographics
NPI:1700372893
Name:SHAH, MEERA (MED, BCBA)
Entity Type:Individual
Prefix:
First Name:MEERA
Middle Name:
Last Name:SHAH
Suffix:
Gender:F
Credentials:MED, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8809 W BRYN MAWR AVE
Mailing Address - Street 2:STE 204
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60531-3524
Mailing Address - Country:US
Mailing Address - Phone:773-644-7787
Mailing Address - Fax:
Practice Address - Street 1:8809 W BRYN MAWR AVE
Practice Address - Street 2:STE 204
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60531-3524
Practice Address - Country:US
Practice Address - Phone:773-644-7787
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-02
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILRBT-16-27554106S00000X
IL1-19-34693103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician