MEDICARE: KAYLA DEBENEDITTIS MS, 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	1-20-40837	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	:	1083005003
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAYLA DEBENEDITTIS MS, BCBA

Provider Business Mailing Address
First Line	:	1280 MONUMENT AVE SE
Second Line	:
City	:	PALM BAY
State	:	FL
Zip	:	32909-8510
Country	:	US
Telephone Number	:	321-271-0455
Fax Number	:

Provider Business Practice Location Address
First Line	:	1280 MONUMENT AVE SE
Second Line	:
City	:	PALM BAY
State	:	FL
Zip	:	32909-8510
Country	:	US
Telephone Number	:	321-271-0455
Fax Number	:

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

Provider Enumeration Date	:	02/12/2015
Last Update Date	:	06/18/2024

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