MEDICARE: MIRANDA SADLOW M.S., BCBA, LABA

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	10000065	MA

General Provider Information

NPI Number	:	1447039136
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIRANDA SADLOW M.S., BCBA, LABA

Provider Business Mailing Address
First Line	:	PO BOX 271
Second Line	:
City	:	WINDSOR
State	:	MA
Zip	:	01270-0271
Country	:	US
Telephone Number	:	413-242-4816
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 HUMES RD
Second Line	:
City	:	WINDSOR
State	:	MA
Zip	:	01270-9298
Country	:	US
Telephone Number	:	413-372-6325
Fax Number	:

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

Provider Enumeration Date	:	09/22/2023
Last Update Date	:	09/22/2023

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