MEDICARE: TANEEKA RENEE BUCHANAN

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	1220216	VA

General Provider Information

NPI Number	:	1578370482
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TANEEKA RENEE BUCHANAN

Provider Business Mailing Address
First Line	:	14884 EMBERDALE DR
Second Line	:
City	:	WOODBRIDGE
State	:	VA
Zip	:	22193-2678
Country	:	US
Telephone Number	:	703-986-9774
Fax Number	:

Provider Business Practice Location Address
First Line	:	7600 LEESBURGE PIKE WEST BLDG SUITE 204
Second Line	:	WEST BUILDING SUITE 204
City	:	ARLINGTON
State	:	VA
Zip	:	22043
Country	:	US
Telephone Number	:	703-553-3131
Fax Number	:

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

Provider Enumeration Date	:	12/13/2024
Last Update Date	:	12/13/2024

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