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NPI Code Detail

MEDICARE: STEPHANIE MALDONADO

MEDICARE: STEPHANIE MALDONADO
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
1103K00000XBehavior Analyst1-18-30270

General Provider Information

NPI Number : 1194177048
Entity Type Code : Individual
Provider Name (Legal Business Name) : STEPHANIE MALDONADO
Provider Business Mailing Address
First Line : 8736 INDIGO LN
Second Line :
City : YPSILANTI
State : MI
Zip : 48197-1065
Country : US
Telephone Number : 787-955-8110
Fax Number :
Provider Business Practice Location Address
First Line : 19853 OUTER DR
Second Line :
City : DEARBORN
State : MI
Zip : 48124-2066
Country : US
Telephone Number : 313-633-0967
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/04/2016
Last Update Date : 09/26/2019

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Directions to “ STEPHANIE MALDONADO ” Practice Location

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