Healthcare Provider Details

I. General information

NPI: 1427614072
Provider Name (Legal Business Name): AUGUSTA IWARIA INEGBEDION
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2019
Last Update Date: 10/31/2024
Certification Date: 10/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1647 NE 124TH LN
NORTH MIAMI FL
33181-2543
US

IV. Provider business mailing address

1647 NE 124TH LN
NORTH MIAMI FL
33181-2543
US

V. Phone/Fax

Practice location:
  • Phone: 202-813-6946
  • Fax:
Mailing address:
  • Phone: 202-813-6946
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-24-76339
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-19-04-23
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: