Provider Demographics
NPI:1134929193
Name:RUNLES, SHAMEQUA VILINDA
Entity type:Individual
Prefix:
First Name:SHAMEQUA
Middle Name:VILINDA
Last Name:RUNLES
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4015 S MAIN ST # 2604
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46614-2525
Mailing Address - Country:US
Mailing Address - Phone:574-383-6284
Mailing Address - Fax:
Practice Address - Street 1:1629 WEST EWING AVE
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46613
Practice Address - Country:US
Practice Address - Phone:574-383-6284
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-18
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INRBT-24-389798106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician