MEDICARE: TANEJAH M BUNTLEY

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	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1659099844
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TANEJAH M BUNTLEY

Provider Business Mailing Address
First Line	:	1513 COLLEGEVIEW AVE APT 101
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27606-4869
Country	:	US
Telephone Number	:	585-351-4207
Fax Number	:

Provider Business Practice Location Address
First Line	:	1513 COLLEGEVIEW AVE APT 101
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27606-4869
Country	:	US
Telephone Number	:	585-351-4207
Fax Number	:

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

Provider Enumeration Date	:	08/15/2022
Last Update Date	:	08/15/2022

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Directions to “ TANEJAH M BUNTLEY ” Practice Location

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