MEDICARE: DARLIE GIOVANNIE EGUABOR

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		NY

General Provider Information

NPI Number	:	1194573865
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DARLIE GIOVANNIE EGUABOR

Provider Business Mailing Address
First Line	:	911 E 229TH ST APT 2R
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10466-4659
Country	:	US
Telephone Number	:	917-843-7172
Fax Number	:

Provider Business Practice Location Address
First Line	:	911 E 229TH ST APT 2R
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10466-4659
Country	:	US
Telephone Number	:	917-843-7172
Fax Number	:

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

Provider Enumeration Date	:	05/08/2024
Last Update Date	:	05/08/2024

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