Healthcare Provider Details

I. General information

NPI: 1871095752
Provider Name (Legal Business Name): BRITTANY NYAMADZAWO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2018
Last Update Date: 07/18/2024
Certification Date: 03/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4540 HARLIN DR
SACRAMENTO CA
95826-9716
US

IV. Provider business mailing address

8355 WHEATLAND DR
SACRAMENTO CA
95828-6702
US

V. Phone/Fax

Practice location:
  • Phone: 916-364-7800
  • Fax:
Mailing address:
  • Phone: 916-390-3427
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-21-47831
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number1624913
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: