MEDICARE: CDA MEDICAL, PLLC

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	172V00000X	Community Health Worker

General Provider Information

NPI Number	:	1134088156
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CDA MEDICAL, PLLC

Provider Business Mailing Address
First Line	:	4343 EAST OUTLIER BLV.
Second Line	:	SUITE 100W
City	:	PHOENIX
State	:	AZ
Zip	:	85008-6507
Country	:	US
Telephone Number	:	844-358-8648
Fax Number	:	877-877-6875

Provider Business Practice Location Address
First Line	:	207 HALLOCK RD
Second Line	:	SUITE 201
City	:	STONY BROOK
State	:	NY
Zip	:	11790
Country	:	US
Telephone Number	:	877-358-8648
Fax Number	:	877-877-6875

Authorized Official
Title or Position	:	MEDICAL BILLING SPECIALIST
Name	:	JUANA SLACK
Credential	:
Telephone Number	:	480-646-9086

Provider Enumeration Date	:	01/16/2026
Last Update Date	:	01/16/2026

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