Provider Demographics
NPI:1962861617
Name:DUKES, SHAUN
Entity Type:Individual
Prefix:MR
First Name:SHAUN
Middle Name:
Last Name:DUKES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1260 E 2ND ST
Mailing Address - Street 2:APT 9
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90802-5770
Mailing Address - Country:US
Mailing Address - Phone:562-852-7325
Mailing Address - Fax:
Practice Address - Street 1:1260 E 2ND ST
Practice Address - Street 2:APT 9
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90802-5770
Practice Address - Country:US
Practice Address - Phone:562-852-7325
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-22
Last Update Date:2016-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst