MEDICARE: SARATH CRISTINA 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
1	247200000X	Other Technician
2	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1972019933
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARATH CRISTINA MALDONADO

Provider Business Mailing Address
First Line	:	7108 S KANNER HWY
Second Line	:
City	:	STUART
State	:	FL
Zip	:	34997-7462
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1818 S AUSTRALIAN AVE
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33409-6452
Country	:	US
Telephone Number	:	855-832-6727
Fax Number	:

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

Provider Enumeration Date	:	12/28/2017
Last Update Date	:	12/28/2017

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