MEDICARE: ASHLEY NICHOLE DIMEGLIO 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	1-17-28100

General Provider Information

NPI Number	:	1457869299
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY NICHOLE DIMEGLIO M.A., BCBA

Provider Business Mailing Address
First Line	:	2401 KINGSBURY DR
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28205-6124
Country	:	US
Telephone Number	:	586-610-9222
Fax Number	:

Provider Business Practice Location Address
First Line	:	525 N TRYON ST STE 1500
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28202-0202
Country	:	US
Telephone Number	:	855-832-6727
Fax Number	:

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

Provider Enumeration Date	:	01/15/2018
Last Update Date	:	11/17/2020

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