MEDICARE: MICHELLE MENDOZA

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
2	106S00000X	Behavior Technician	22-228666	MD

General Provider Information

NPI Number	:	1174252373
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE MENDOZA

Provider Business Mailing Address
First Line	:	5290 SHAWNEE RD STE 220
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22312-2381
Country	:	US
Telephone Number	:	703-539-8616
Fax Number	:

Provider Business Practice Location Address
First Line	:	5290 SHAWNEE RD STE 220
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22312-2381
Country	:	US
Telephone Number	:	703-539-8616
Fax Number	:

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

Provider Enumeration Date	:	06/06/2022
Last Update Date	:	01/05/2025

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Directions to “ MICHELLE MENDOZA ” Practice Location

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