MEDICARE: MRS. ELIZABETH MICHELLE LANDES

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		VA

General Provider Information

NPI Number	:	1780514554
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ELIZABETH MICHELLE LANDES

Provider Business Mailing Address
First Line	:	3433 BRAMBLETON AVE
Second Line	:
City	:	ROANOKE
State	:	VA
Zip	:	24018-6515
Country	:	US
Telephone Number	:	804-562-9997
Fax Number	:

Provider Business Practice Location Address
First Line	:	3433 BRAMBLETON AVE
Second Line	:
City	:	ROANOKE
State	:	VA
Zip	:	24018-6515
Country	:	US
Telephone Number	:	804-562-9997
Fax Number	:

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

Provider Enumeration Date	:	05/21/2026
Last Update Date	:	05/21/2026

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