MEDICARE: RAMAN PHULL

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	:	1932484730
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAMAN PHULL

Provider Business Mailing Address
First Line	:	12649 NW 18TH MNR
Second Line	:
City	:	PEMBROKE PINES
State	:	FL
Zip	:	33028-2519
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6973 UNIVERSITY BLVD
Second Line	:
City	:	WINTER PARK
State	:	FL
Zip	:	32792-2519
Country	:	US
Telephone Number	:	954-805-8895
Fax Number	:

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

Provider Enumeration Date	:	10/13/2011
Last Update Date	:	03/03/2021

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Directions to “ RAMAN PHULL ” Practice Location

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