Healthcare Provider Details

I. General information

NPI: 1588527840
Provider Name (Legal Business Name): MALAYA BRYONN DOBBINS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2025
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

452 N EOLA RD STE A
AURORA IL
60502-9110
US

IV. Provider business mailing address

452 N EOLA RD STE A
AURORA IL
60502-9110
US

V. Phone/Fax

Practice location:
  • Phone: 888-308-3728
  • Fax:
Mailing address:
  • Phone: 888-308-3728
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: