Provider Demographics
NPI:1831719111
Name:KLOBY, SHAUN
Entity type:Individual
Prefix:
First Name:SHAUN
Middle Name:
Last Name:KLOBY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13575 58TH ST N STE 114
Mailing Address - Street 2:MAILBOX #132
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33760-3755
Mailing Address - Country:US
Mailing Address - Phone:949-401-3931
Mailing Address - Fax:888-403-6922
Practice Address - Street 1:13575 58TH ST N STE 114
Practice Address - Street 2:MAILBOX #132
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33760-3755
Practice Address - Country:US
Practice Address - Phone:949-401-3931
Practice Address - Fax:888-403-6922
Is Sole Proprietor?:No
Enumeration Date:2020-04-16
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-19-38925103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst