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General NPI Number Information
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NPI Number | 1134088156
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Entity Type | Organization
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Legal Business Name | CDA MEDICAL, PLLC
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Dates
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Enumeration Date | 01/16/2026
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Last Update Date | 01/16/2026
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Provider Practice Location Address
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Address Line | 207 HALLOCK RD SUITE 201
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City | STONY BROOK
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State | NY
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Zip | 11790
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Country | US
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Telephone | 877-358-8648
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Fax | 877-877-6875
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Provider Business Mailing Address
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Address Line | 4343 EAST OUTLIER BLV. SUITE 100W
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City | PHOENIX
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State | AZ
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Zip | 85008-6507
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Country | US
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Telephone | 844-358-8648
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Fax | 877-877-6875
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Authorized Official
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Title or Position | MEDICAL BILLING SPECIALIST
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Name | JUANA SLACK
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Credential |
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Telephone | 480-646-9086
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number |
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License Number State |
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