Provider Demographics
NPI:1578285953
Name:STEWART, SHELBY RYANN (BCBA)
Entity type:Individual
Prefix:
First Name:SHELBY
Middle Name:RYANN
Last Name:STEWART
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:SHELBY
Other - Middle Name:RYANN
Other - Last Name:STEARSMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RBT
Mailing Address - Street 1:2100 LIBERTY RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-4319
Mailing Address - Country:US
Mailing Address - Phone:502-777-2397
Mailing Address - Fax:
Practice Address - Street 1:907 LYNDON LN
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40222-3815
Practice Address - Country:US
Practice Address - Phone:502-777-2397
Practice Address - Fax:502-236-1318
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-13
Last Update Date:2025-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1-25-80838103K00000X, 103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst