Healthcare Provider Details

I. General information

NPI: 1356980098
Provider Name (Legal Business Name): AIMEE ALYSSA SIEGEL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/28/2019
Last Update Date: 12/28/2019
Certification Date: 12/28/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

703 HILLSBORO DR
SILVER SPRING MD
20902-3218
US

IV. Provider business mailing address

703 HILLSBORO DR
SILVER SPRING MD
20902-3218
US

V. Phone/Fax

Practice location:
  • Phone: 201-981-9180
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberBACB541178
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: