Provider Demographics
NPI:1437891611
Name:BERMUDEZ, SHAINA (BCBA)
Entity type:Individual
Prefix:
First Name:SHAINA
Middle Name:
Last Name:BERMUDEZ
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 DUNVEGAN DR
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29414-6939
Mailing Address - Country:US
Mailing Address - Phone:803-767-0663
Mailing Address - Fax:
Practice Address - Street 1:1 DUNVEGAN DR
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29414-6939
Practice Address - Country:US
Practice Address - Phone:803-767-0663
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-08
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst