Individual
SHANDA S KILLEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
6162 VANDIKE ST FL 1, PHILADELPHIA, PA 19135-3723
(215) 416-5011
Mailing address
6162 VANDIKE STREET, 1ST FLOOR, PHILADELPHIA, PA 19135
(215) 416-5011
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
800012097
—
PA
Enumeration date
04/22/2019
Last updated
04/22/2019
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