Provider Demographics
NPI:1326914763
Name:NEAL, SHANEA JASMINE
Entity type:Individual
Prefix:
First Name:SHANEA
Middle Name:JASMINE
Last Name:NEAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 MILBERT CT # 2A
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-4529
Mailing Address - Country:US
Mailing Address - Phone:443-460-8709
Mailing Address - Fax:
Practice Address - Street 1:5740 EXECUTIVE DR STE 114
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21228-1331
Practice Address - Country:US
Practice Address - Phone:410-609-6357
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-10-14
Last Update Date:2025-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDRBT-25-416916106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician