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General NPI Number Information
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NPI Number | 1134006695
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Entity Type | Individual
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Provider Name | RODRIGO STALLARD
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Gender |
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Dates
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Enumeration Date | 08/18/2025
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Last Update Date | 08/18/2025
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Provider Practice Location Address
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Address Line | 4734 217TH ST APT 3C
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City | BAYSIDE
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State | NY
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Zip | 11361-3570
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Country | US
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Telephone | 305-904-9841
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Fax | 305-904-9841
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Provider Business Mailing Address
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Address Line | 4734 217TH ST APT 3C
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City | BAYSIDE
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State | NY
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Zip | 11361
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Country | US
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Telephone | 305-904-9841
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | P130414
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License Number State | NY
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