Healthcare Provider Details

I. General information

NPI: 1649102427
Provider Name (Legal Business Name): MAKALAH BANKS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2026
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2666 STATE ST STE A3
HAMDEN CT
06517-2232
US

IV. Provider business mailing address

24 HIGHLAND DR
NORTH HAVEN CT
06473-2917
US

V. Phone/Fax

Practice location:
  • Phone: 860-544-0356
  • Fax:
Mailing address:
  • Phone: 475-330-0323
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number149568877
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: