MEDICARE: CHARLSEY REYNOLDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst
2	103K00000X	Behavior Analyst		FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053668624
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLSEY REYNOLDS

Provider Business Mailing Address
First Line	:	350 FAIRWAY DR FL STE 101
Second Line	:
City	:	DEERFIELD BEACH
State	:	FL
Zip	:	33441-1834
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10004 N DALE MABRY HWY STE 102
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33618-4421
Country	:	US
Telephone Number	:	877-418-2978
Fax Number	:	866-500-2186

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/13/2012
Last Update Date	:	09/23/2024

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Directions to “ CHARLSEY REYNOLDS ” Practice Location

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