MEDICARE: MAYELIN IMAS

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	106S00000X	Behavior Technician		FL

General Provider Information

NPI Number	:	1063288793
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAYELIN IMAS

Provider Business Mailing Address
First Line	:	13999 SW 142ND ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33186-5560
Country	:	US
Telephone Number	:	305-796-3236
Fax Number	:

Provider Business Practice Location Address
First Line	:	13999 SW 142ND ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33186-5560
Country	:	US
Telephone Number	:	305-796-3236
Fax Number	:

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

Provider Enumeration Date	:	12/04/2023
Last Update Date	:	12/04/2023

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Directions to “ MAYELIN IMAS ” Practice Location

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