MEDICARE: MADELINE VIRGINIA PERNELL ADOMAITIS

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		FL

General Provider Information

NPI Number	:	1235062985
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MADELINE VIRGINIA PERNELL ADOMAITIS

Provider Business Mailing Address
First Line	:	PO BOX 10827
Second Line	:
City	:	TALLAHASSEE
State	:	FL
Zip	:	32302-2827
Country	:	US
Telephone Number	:	850-521-0242
Fax Number	:

Provider Business Practice Location Address
First Line	:	3223 NW 10TH TER
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33309-5940
Country	:	US
Telephone Number	:	850-521-0242
Fax Number	:

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

Provider Enumeration Date	:	06/03/2026
Last Update Date	:	06/04/2026

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Directions to “ MADELINE VIRGINIA PERNELL ADOMAITIS ” Practice Location

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