Healthcare Provider Details

I. General information

NPI: 1972170314
Provider Name (Legal Business Name): MAYRA ALEXANDRA NUNEZ M.S., BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2021
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6510 TOWN CENTER DR STE E
CLARKSTON MI
48346-4822
US

IV. Provider business mailing address

14544 SW 95TH LN
MIAMI FL
33186-1038
US

V. Phone/Fax

Practice location:
  • Phone: 248-965-0417
  • Fax:
Mailing address:
  • Phone: 305-720-4416
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: