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NPI Code Detail

MEDICARE: CHRISTIANA WELLS

MEDICARE: CHRISTIANA WELLS
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
1106S00000XBehavior Technician
2103K00000XBehavior Analyst

Other Identifiers

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

General Provider Information

NPI Number : 1053844167
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHRISTIANA WELLS
Provider Business Mailing Address
First Line : 6804 PLANTING ST APT 6306
Second Line :
City : WINTER GARDEN
State : FL
Zip : 34787-8730
Country : US
Telephone Number : 407-797-0672
Fax Number :
Provider Business Practice Location Address
First Line : 13650 W COLONIAL DR STE 150
Second Line :
City : WINTER GARDEN
State : FL
Zip : 34787-3994
Country : US
Telephone Number : 302-334-8603
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/05/2017
Last Update Date : 06/01/2023

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Directions to “ CHRISTIANA WELLS ” Practice Location

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