MEDICARE: CLINTON K ANYAMELE

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	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1194328559
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CLINTON K ANYAMELE

Provider Business Mailing Address
First Line	:	7200 EDEN BROOK DR APT D202
Second Line	:
City	:	COLUMBIA
State	:	MD
Zip	:	21046-1459
Country	:	US
Telephone Number	:	240-579-0807
Fax Number	:

Provider Business Practice Location Address
First Line	:	7200 EDEN BROOK DR APT D202
Second Line	:
City	:	COLUMBIA
State	:	MD
Zip	:	21046-1459
Country	:	US
Telephone Number	:	240-579-0807
Fax Number	:

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

Provider Enumeration Date	:	11/18/2020
Last Update Date	:	11/18/2020

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Directions to “ CLINTON K ANYAMELE ” Practice Location

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