MEDICARE: JACKELINE L VALLADARES

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

General Provider Information

NPI Number	:	1093451437
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACKELINE L VALLADARES

Provider Business Mailing Address
First Line	:	168 NW 15TH PL
Second Line	:
City	:	POMPANO BEACH
State	:	FL
Zip	:	33060-5463
Country	:	US
Telephone Number	:	954-618-3670
Fax Number	:

Provider Business Practice Location Address
First Line	:	3223 NW 10TH TER STE 610
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33309-5940
Country	:	US
Telephone Number	:	954-804-5950
Fax Number	:

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

Provider Enumeration Date	:	05/09/2022
Last Update Date	:	05/09/2022

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Directions to “ JACKELINE L VALLADARES ” Practice Location

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