MEDICARE: MAYELIN PEDRAJA CALZADA

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-24-359315	FL

General Provider Information

NPI Number	:	1104653179
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAYELIN PEDRAJA CALZADA

Provider Business Mailing Address
First Line	:	1246 SUMMIT OAKS DR W
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32221-3237
Country	:	US
Telephone Number	:	904-660-9990
Fax Number	:

Provider Business Practice Location Address
First Line	:	1246 SUMMIT OAKS DR W
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32221-3237
Country	:	US
Telephone Number	:	904-660-9990
Fax Number	:

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

Provider Enumeration Date	:	09/16/2024
Last Update Date	:	10/02/2024

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Directions to “ MAYELIN PEDRAJA CALZADA ” Practice Location

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