Healthcare Provider Details

I. General information

NPI: 1588576110
Provider Name (Legal Business Name): MUKEH SENESIE MAYAH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2026
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 ALFRED DR APT C
LANSDOWNE PA
19050-4169
US

IV. Provider business mailing address

2000 ALFRED DR APT C
LANSDOWNE PA
19050-4169
US

V. Phone/Fax

Practice location:
  • Phone: 445-208-8901
  • Fax:
Mailing address:
  • Phone: 445-208-8901
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBH008599
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: