Most Relevant Information
Provider Data
| NPI Number: | 1003523986 |
| Provider Name: | SHAMIR WADE |
| Entity Type: | Individual |
| Taxonomy Code: | 106S00000X |
| Specialty: | Behavior Technician |
| License Number: |
Most Important Dates
| Enumeration Date: | 11/01/2022 |
| Last Updated: | 11/01/2022 |
Provider Practice Location
1011 MEADOWLANDS DR STE 1
WHITE BEAR LAKE
MN
551272340
Practice Location Phone/Fax
| Phone: | 6124450300 |
| Fax: |
Provider Mailing Location
1011 MEADOWLANDS DR STE 1
WHITE BEAR LAKE
MN
551272340
Provider Mailing Phone/Fax
| Phone: | 6124450300 |
| Fax: |