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General NPI Number Information
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NPI Number | 1861355331
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Entity Type | Individual
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Provider Name | JAYANAH BANTUM
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Gender |
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Dates
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Enumeration Date | 12/03/2025
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Last Update Date | 12/03/2025
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Provider Practice Location Address
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Address Line | 500 REDLAND CT
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City | OWINGS MILLS
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State | MD
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Zip | 21117-3264
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Country | US
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Telephone | 201-979-1336
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Fax |
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Provider Business Mailing Address
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Address Line | 175 BELGROVE DR
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City | KEARNY
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State | NJ
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Zip | 07032-1507
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Country | US
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Telephone | 201-979-1336
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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 | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State | MD
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