MEDICARE: NALEISHA-ANN KEALOHILANI SATELE

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		GA

General Provider Information

NPI Number	:	1376302000
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NALEISHA-ANN KEALOHILANI SATELE

Provider Business Mailing Address
First Line	:	5012 BURLING MILL DR
Second Line	:
City	:	STONECREST
State	:	GA
Zip	:	30038-3748
Country	:	US
Telephone Number	:	470-722-4870
Fax Number	:

Provider Business Practice Location Address
First Line	:	5012 BURLING MILL DR
Second Line	:
City	:	STONECREST
State	:	GA
Zip	:	30038-3748
Country	:	US
Telephone Number	:	470-722-4870
Fax Number	:

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

Provider Enumeration Date	:	03/15/2024
Last Update Date	:	03/15/2024

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