MEDICARE: NIVIDAY ROSS RBT

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	RBT-19-75686	FL
2	106S00000X	Behavior Technician	RBT-19-75686

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	:	1093289381
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NIVIDAY ROSS RBT

Provider Business Mailing Address
First Line	:	14155 SW 87TH ST APT 101E
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33183-4409
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	14155 SW 87TH ST APT 101E
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33183-4409
Country	:	US
Telephone Number	:	305-812-1278
Fax Number	:

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

Provider Enumeration Date	:	01/20/2019
Last Update Date	:	01/20/2019

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Directions to “ NIVIDAY ROSS RBT” Practice Location

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