Provider Demographics
NPI:1053950485
Name:LANDSBERRY, SHAYNA RAELYNN (MA, BCBA, LBA)
Entity type:Individual
Prefix:
First Name:SHAYNA
Middle Name:RAELYNN
Last Name:LANDSBERRY
Suffix:
Gender:F
Credentials:MA, BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:950 28TH AVE SW STE 2
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:IA
Mailing Address - Zip Code:50009-3940
Mailing Address - Country:US
Mailing Address - Phone:515-446-2075
Mailing Address - Fax:
Practice Address - Street 1:950 28TH AVE SW STE 2
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:IA
Practice Address - Zip Code:50009-3940
Practice Address - Country:US
Practice Address - Phone:515-446-2075
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-02
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA123043103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst