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NPI Code Detail

MEDICARE: MIKAYLA GERSHENSON

MEDICARE: MIKAYLA GERSHENSON
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 Analyst1-24-78153
2106S00000XBehavior Technician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1376240630
Entity Type Code : Individual
Provider Name (Legal Business Name) : MIKAYLA GERSHENSON
Provider Business Mailing Address
First Line : 301 174TH ST APT M3
Second Line :
City : SUNNY ISLES BEACH
State : FL
Zip : 33160-3228
Country : US
Telephone Number : 718-710-8821
Fax Number :
Provider Business Practice Location Address
First Line : 3911 SW 56TH CT
Second Line :
City : FT LAUDERDALE
State : FL
Zip : 33312-6227
Country : US
Telephone Number : 305-988-5115
Fax Number : 305-402-8554
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/07/2023
Last Update Date : 12/16/2024

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