MEDICARE: TAQUESE ELLISON

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
2	103K00000X	Behavior Analyst	004056	NY

General Provider Information

NPI Number	:	1871080473
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAQUESE ELLISON

Provider Business Mailing Address
First Line	:	1007 BAY DR APT 201
Second Line	:
City	:	MIAMI BEACH
State	:	FL
Zip	:	33141-3731
Country	:	US
Telephone Number	:	470-439-0026
Fax Number	:

Provider Business Practice Location Address
First Line	:	1007 BAY DR APT 201
Second Line	:
City	:	MIAMI BEACH
State	:	FL
Zip	:	33141-3731
Country	:	US
Telephone Number	:	470-439-0026
Fax Number	:

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

Provider Enumeration Date	:	04/18/2018
Last Update Date	:	03/31/2025

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Directions to “ TAQUESE ELLISON ” Practice Location

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