Provider Demographics
NPI:1871861526
Name:SHAFTO, DANIEL LEE (MA BCBA)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:LEE
Last Name:SHAFTO
Suffix:
Gender:M
Credentials:MA BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1336 E MADISON ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46617-2431
Mailing Address - Country:US
Mailing Address - Phone:219-575-0935
Mailing Address - Fax:574-287-1898
Practice Address - Street 1:1336 E MADISON ST
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46617-2431
Practice Address - Country:US
Practice Address - Phone:219-575-0935
Practice Address - Fax:574-287-1898
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-09
Last Update Date:2011-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst