Provider Demographics
NPI:1730978982
Name:FISHER, SHADESTINY NACHAE
Entity type:Individual
Prefix:
First Name:SHADESTINY
Middle Name:NACHAE
Last Name:FISHER
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21717 INVERNESS FOREST BLVD APT 1502
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77073-1349
Mailing Address - Country:US
Mailing Address - Phone:346-522-5771
Mailing Address - Fax:
Practice Address - Street 1:17507 STERLING STONE DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77073-2765
Practice Address - Country:US
Practice Address - Phone:713-380-5248
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-05
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXRBT-24-384974106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician