Provider Demographics
NPI:1467282129
Name:DANIELS, SHALONDA KISHAN-MARIE
Entity type:Individual
Prefix:MISS
First Name:SHALONDA
Middle Name:KISHAN-MARIE
Last Name:DANIELS
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 1:12250 S KIRKWOOD RD APT 726
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:TX
Mailing Address - Zip Code:77477-2121
Mailing Address - Country:US
Mailing Address - Phone:713-280-6949
Mailing Address - Fax:
Practice Address - Street 1:12250 S KIRKWOOD RD APT 726
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:TX
Practice Address - Zip Code:77477-2121
Practice Address - Country:US
Practice Address - Phone:713-280-6949
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-06
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXRBT-24-330990106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician