MEDICARE: MADELYN UPTHEGROVE BCBA

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

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	:	1508255456
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MADELYN UPTHEGROVE BCBA

Provider Business Mailing Address
First Line	:	6416 NW 5TH WAY
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33309-6112
Country	:	US
Telephone Number	:	888-754-0398
Fax Number	:	954-982-6491

Provider Business Practice Location Address
First Line	:	5798 S SEMORAN BLVD
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32822-4819
Country	:	US
Telephone Number	:	888-754-0398
Fax Number	:	954-982-6491

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

Provider Enumeration Date	:	01/15/2015
Last Update Date	:	04/03/2025

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