MEDICARE: MALKA DYM BCBA

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	1-22-57549	OH

General Provider Information

NPI Number	:	1073255600
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MALKA DYM BCBA

Provider Business Mailing Address
First Line	:	4285 UNIVERSITY PKWY
Second Line	:
City	:	UNIVERSITY HEIGHTS
State	:	OH
Zip	:	44118-3942
Country	:	US
Telephone Number	:	216-296-4255
Fax Number	:

Provider Business Practice Location Address
First Line	:	4285 UNIVERSITY PKWY
Second Line	:
City	:	UNIVERSITY HEIGHTS
State	:	OH
Zip	:	44118-3942
Country	:	US
Telephone Number	:	216-296-4255
Fax Number	:

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

Provider Enumeration Date	:	04/13/2022
Last Update Date	:	04/13/2022

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