MEDICARE: AUNTIE'S EARLY ENRICHMENT, LLC

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
1	252Y00000X	Early Intervention Provider Agency

General Provider Information

NPI Number	:	1134052350
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AUNTIE'S EARLY ENRICHMENT, LLC

Provider Business Mailing Address
First Line	:	160 HIGHLAND AVE
Second Line	:
City	:	MIDDLETOWN
State	:	NY
Zip	:	10940-4713
Country	:	US
Telephone Number	:	646-316-0203
Fax Number	:

Provider Business Practice Location Address
First Line	:	160 HIGHLAND AVE
Second Line	:
City	:	MIDDLETOWN
State	:	NY
Zip	:	10940-4713
Country	:	US
Telephone Number	:	646-316-0203
Fax Number	:

Authorized Official
Title or Position	:	EARLY INTERVENTION
Name	:	TIASHA TAYLOR ROSA
Credential	:	MSED
Telephone Number	:	646-316-0203

Provider Enumeration Date	:	06/06/2026
Last Update Date	:	06/06/2026

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