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NPI Code Detail

MEDICARE: DEIRDRE MYDELL

MEDICARE: DEIRDRE MYDELL
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1073454641
Entity Type Code : Individual
Provider Name (Legal Business Name) : DEIRDRE MYDELL
Provider Business Mailing Address
First Line : 945 N CENTRAL AVE
Second Line :
City : WOODMERE
State : NY
Zip : 11598-1604
Country : US
Telephone Number : 912-398-8736
Fax Number :
Provider Business Practice Location Address
First Line : 11476 S APOPKA VINELAND RD STE 118
Second Line :
City : ORLANDO
State : FL
Zip : 32836-7006
Country : US
Telephone Number : 407-955-4001
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/06/2026
Last Update Date : 04/06/2026

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Directions to “ DEIRDRE MYDELL ” Practice Location

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