Healthcare Provider Details

I. General information

NPI: 1730095381
Provider Name (Legal Business Name): MCKAYLA LYN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7301A W PALMETTO PARK RD STE 100C
BOCA RATON FL
33433-3403
US

IV. Provider business mailing address

4921 W SAMPLE RD APT 402
COCONUT CREEK FL
33073-3444
US

V. Phone/Fax

Practice location:
  • Phone: 954-248-1171
  • Fax:
Mailing address:
  • Phone: 754-281-8071
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberL500-541-02-541-0
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: