MEDICARE: KENDALL POLIDORE

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	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1144170978
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENDALL POLIDORE

Provider Business Mailing Address
First Line	:	2139 LAKE HILLS DR APT 614
Second Line	:
City	:	KINGWOOD
State	:	TX
Zip	:	77339-2303
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	201 KINGWOOD MEDICAL DR STE 450
Second Line	:
City	:	KINGWOOD
State	:	TX
Zip	:	77339-6006
Country	:	US
Telephone Number	:	281-306-3231
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/31/2026
Last Update Date	:	01/31/2026

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Directions to “ KENDALL POLIDORE ” Practice Location

Language	Start Address	Practice Location

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