MEDICARE: CARYNDIA REYNOSO

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	:	1609245604
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARYNDIA REYNOSO

Provider Business Mailing Address
First Line	:	183 PROSPECT PL
Second Line	:
City	:	BAY SHORE
State	:	NY
Zip	:	11706-1509
Country	:	US
Telephone Number	:	917-714-8608
Fax Number	:

Provider Business Practice Location Address
First Line	:	183 PROSPECT PL
Second Line	:
City	:	BAY SHORE
State	:	NY
Zip	:	11706-1509
Country	:	US
Telephone Number	:	917-714-8608
Fax Number	:

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

Provider Enumeration Date	:	09/20/2015
Last Update Date	:	09/20/2015

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Directions to “ CARYNDIA REYNOSO ” Practice Location

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