MEDICARE: MR. FESTUS UZOR ANI NONE

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

General Provider Information

NPI Number	:	1407626369
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. FESTUS UZOR ANI NONE

Provider Business Mailing Address
First Line	:	7108 S KANNER HWY
Second Line	:
City	:	STUART
State	:	FL
Zip	:	34997-7462
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3233 WALTERS LN APT 103
Second Line	:
City	:	DISTRICT HEIGHTS
State	:	MD
Zip	:	20747-3121
Country	:	US
Telephone Number	:	347-264-9309
Fax Number	:

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

Provider Enumeration Date	:	01/03/2024
Last Update Date	:	01/03/2024

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