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NPI Code Detail

MEDICARE: EYORUSALEM SAHLOM

MEDICARE: EYORUSALEM SAHLOM
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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1164938676
Entity Type Code : Individual
Provider Name (Legal Business Name) : EYORUSALEM SAHLOM
Provider Business Mailing Address
First Line : 8200 PROFESSIONAL PL STE 115
Second Line :
City : LANDOVER
State : MD
Zip : 20785-2293
Country : US
Telephone Number : 866-727-8274
Fax Number :
Provider Business Practice Location Address
First Line : 8200 PROFESSIONAL PL STE 115
Second Line :
City : LANDOVER
State : MD
Zip : 20785-2293
Country : US
Telephone Number : 866-727-8274
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/19/2017
Last Update Date : 10/24/2022

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Directions to “ EYORUSALEM SAHLOM ” Practice Location

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