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NPI Code Detail

MEDICARE: NINA MARIE SALLIS BCBA

MEDICARE: NINA MARIE SALLIS 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
1103K00000XBehavior Analyst

General Provider Information

NPI Number : 1629552716
Entity Type Code : Individual
Provider Name (Legal Business Name) : NINA MARIE SALLIS BCBA
Provider Business Mailing Address
First Line : 2024 ROSEBURY LN SW
Second Line :
City : HUNTSVILLE
State : AL
Zip : 35803-1412
Country : US
Telephone Number : 256-503-8946
Fax Number :
Provider Business Practice Location Address
First Line : 4769 WHITESBURG DR SE STE 202
Second Line :
City : HUNTSVILLE
State : AL
Zip : 35802-1684
Country : US
Telephone Number : 256-666-0477
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/24/2018
Last Update Date : 05/03/2022

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