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NPI Code Detail

MEDICARE: SANDERICA HUTTO

MEDICARE: SANDERICA HUTTO
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
1103K00000XBehavior Analyst1-25-85998NC
2103K00000XBehavior Analyst1-25-85998GA
3106S00000XBehavior Technician

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 : 1073143863
Entity Type Code : Individual
Provider Name (Legal Business Name) : SANDERICA HUTTO
Provider Business Mailing Address
First Line : 8701 WADFORD DR STE 100
Second Line :
City : RALEIGH
State : NC
Zip : 27616-9028
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1410 CUSTER AVE SE
Second Line :
City : ATLANTA
State : GA
Zip : 30316-3304
Country : US
Telephone Number : 248-220-7980
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/21/2020
Last Update Date : 12/02/2025

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Directions to “ SANDERICA HUTTO ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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