MEDICARE: MRS. ANGELA DAWN MERANDA B.S., M.A., BCBA

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	:	1306976105
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ANGELA DAWN MERANDA B.S., M.A., BCBA

Provider Business Mailing Address
First Line	:	PO BOX 360
Second Line	:	3830 SOUTH COUNTY ROAD 101 EAST
City	:	CLAYTON
State	:	IN
Zip	:	46118-0360
Country	:	US
Telephone Number	:	317-539-7536
Fax Number	:	317-539-4673

Provider Business Practice Location Address
First Line	:	3830 S COUNTY ROAD 101 E
Second Line	:
City	:	CLAYTON
State	:	IN
Zip	:	46118-9663
Country	:	US
Telephone Number	:	317-539-7536
Fax Number	:	317-539-4673

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

Provider Enumeration Date	:	03/07/2007
Last Update Date	:	10/04/2013

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