=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942024005
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MADELYNE GRACE DOSS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/14/2024
-----------------------------------------------------
Last Update Date | 11/14/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 100 SAUNDERS ST
-----------------------------------------------------
City | CULPEPER
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22701-3826
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 540-738-7720
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1801 SOLOMON RD APT A
-----------------------------------------------------
City | CHARLOTTESVILLE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22901-2422
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 434-257-7356
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106S00000X
-----------------------------------------------------
Taxonomy Name | Behavior Technician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------