Provider Demographics
NPI:1669901971
Name:GUNDLING, SHELBY (MED, BSL, BCBA)
Entity type:Individual
Prefix:
First Name:SHELBY
Middle Name:
Last Name:GUNDLING
Suffix:
Gender:F
Credentials:MED, BSL, BCBA
Other - Prefix:
Other - First Name:SHELBY
Other - Middle Name:
Other - Last Name:BOYLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:721 CRICKLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16803-2113
Mailing Address - Country:US
Mailing Address - Phone:610-533-8544
Mailing Address - Fax:
Practice Address - Street 1:721 CRICKLEWOOD DR
Practice Address - Street 2:
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16803-2113
Practice Address - Country:US
Practice Address - Phone:610-533-8544
Practice Address - Fax:610-533-8544
Is Sole Proprietor?:No
Enumeration Date:2017-06-08
Last Update Date:2017-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-17-256131-17-25613103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst