Provider Demographics
NPI:1205301991
Name:TEW, SHASTA BRIANNE (BCBA)
Entity type:Individual
Prefix:
First Name:SHASTA
Middle Name:BRIANNE
Last Name:TEW
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 1:8862 BELLAWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32514-3109
Mailing Address - Country:US
Mailing Address - Phone:850-305-1227
Mailing Address - Fax:
Practice Address - Street 1:8862 BELLAWOOD CIR
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32514-3109
Practice Address - Country:US
Practice Address - Phone:850-305-1227
Practice Address - Fax:850-305-1227
Is Sole Proprietor?:No
Enumeration Date:2018-10-09
Last Update Date:2021-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst