Provider Demographics
NPI:1366189391
Name:SHREWSBURY, NICHOLAS A (BCBA)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:A
Last Name:SHREWSBURY
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 BUFORD HWY APT 3314
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-7806
Mailing Address - Country:US
Mailing Address - Phone:470-622-9475
Mailing Address - Fax:
Practice Address - Street 1:5050 RESEARCH CT STE 125
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-5573
Practice Address - Country:US
Practice Address - Phone:470-622-9475
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-20
Last Update Date:2022-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst