Individual
SHADAE MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
44 MALBONE ST # 3, PROVIDENCE, RI 02908-3629
(978) 918-0483
Mailing address
44 MALBONE ST # 3, PROVIDENCE, RI 02908-3629
(978) 918-0483
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
01/21/2021
Last updated
01/21/2021
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