MEDICARE: SALLY MCKENNEY

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	:	1487889440
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SALLY MCKENNEY

Provider Business Mailing Address
First Line	:	1825 NW 167TH ST
Second Line	:	SUITE #102
City	:	MIAMI GARDENS
State	:	FL
Zip	:	33056-4838
Country	:	US
Telephone Number	:	305-624-7450
Fax Number	:	305-623-7893

Provider Business Practice Location Address
First Line	:	11530 SW 51ST ST
Second Line	:
City	:	COOPER CITY
State	:	FL
Zip	:	33330-4253
Country	:	US
Telephone Number	:	305-624-7450
Fax Number	:	305-623-7893

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

Provider Enumeration Date	:	05/20/2009
Last Update Date	:	05/20/2009

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Directions to “ SALLY MCKENNEY ” Practice Location

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