Healthcare Provider Details

I. General information

NPI: 1194363978
Provider Name (Legal Business Name): MONIQUE LABASTIDA-SANCHEZ LBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2019
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 WELLHAM AVE
GLEN BURNIE MD
21061-2309
US

IV. Provider business mailing address

711 WELLHAM AVE
GLEN BURNIE MD
21061-2309
US

V. Phone/Fax

Practice location:
  • Phone: 301-659-8842
  • Fax:
Mailing address:
  • Phone: 301-659-8842
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberLBA2851
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: