MEDICARE: DALLAMY SIS MOREIRA

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	RBT-18-71211	FL

Other Identifiers

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

General Provider Information

NPI Number	:	1497269021
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DALLAMY SIS MOREIRA

Provider Business Mailing Address
First Line	:	746 SW 2ND ST APT 5
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33130-2342
Country	:	US
Telephone Number	:	786-805-7832
Fax Number	:

Provider Business Practice Location Address
First Line	:	14750 SW 26TH ST STE 114
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33185-5934
Country	:	US
Telephone Number	:	786-536-9441
Fax Number	:

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

Provider Enumeration Date	:	11/17/2017
Last Update Date	:	11/27/2018

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Directions to “ DALLAMY SIS MOREIRA ” Practice Location

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