Provider Demographics
NPI:1265193502
Name:KLAR, SHAINDY JR (MS ED, BCBA)
Entity type:Individual
Prefix:
First Name:SHAINDY
Middle Name:
Last Name:KLAR
Suffix:JR
Gender:F
Credentials:MS ED, BCBA
Other - Prefix:MISS
Other - First Name:SHAINDY
Other - Middle Name:
Other - Last Name:KLAR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BCBA
Mailing Address - Street 1:4 LIZENSK BLVD UNIT 202
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NY
Mailing Address - Zip Code:10950-6180
Mailing Address - Country:US
Mailing Address - Phone:845-238-0572
Mailing Address - Fax:
Practice Address - Street 1:4 LIZENSK BLVD
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NY
Practice Address - Zip Code:10950-6180
Practice Address - Country:US
Practice Address - Phone:845-238-0572
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-08
Last Update Date:2022-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1-22-57451103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst