MEDICARE: NYEENA DENINE HOWARD

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	:	1649024332
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NYEENA DENINE HOWARD

Provider Business Mailing Address
First Line	:	210 CREST VILLAGE DR
Second Line	:
City	:	DULUTH
State	:	GA
Zip	:	30096-6306
Country	:	US
Telephone Number	:	678-830-4978
Fax Number	:

Provider Business Practice Location Address
First Line	:	761 PEACHTREE PKWY
Second Line	:
City	:	CUMMING
State	:	GA
Zip	:	30041-9352
Country	:	US
Telephone Number	:	678-810-1764
Fax Number	:

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

Provider Enumeration Date	:	04/17/2024
Last Update Date	:	04/17/2024

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