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NPI Code Detail

MEDICARE: JACKELYN MARIE MALDONADO

MEDICARE: JACKELYN MARIE MALDONADO
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
1106E00000XAssistant Behavior Analyst0-26-17019FL

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 : 1740895424
Entity Type Code : Individual
Provider Name (Legal Business Name) : JACKELYN MARIE MALDONADO
Provider Business Mailing Address
First Line : 1105 W RUSSELL ST
Second Line :
City : SIOUX FALLS
State : SD
Zip : 57104-1322
Country : US
Telephone Number : 605-271-2690
Fax Number : 605-271-3956
Provider Business Practice Location Address
First Line : 1310 OVIEDO MALL BLVD
Second Line :
City : OVIEDO
State : FL
Zip : 32765-7418
Country : US
Telephone Number : 605-271-2690
Fax Number : 605-271-3956
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/10/2020
Last Update Date : 05/11/2026

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Directions to “ JACKELYN MARIE MALDONADO ” Practice Location

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