MEDICARE: MRS. MARIA CANDIDA POTDAR

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	1-21-56739	FL

General Provider Information

NPI Number	:	1659782639
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARIA CANDIDA POTDAR

Provider Business Mailing Address
First Line	:	6049 NOCKLYN RD
Second Line	:
City	:	SPRING HILL
State	:	FL
Zip	:	34609-8720
Country	:	US
Telephone Number	:	412-720-4789
Fax Number	:

Provider Business Practice Location Address
First Line	:	36947 COOK ST STE 101
Second Line	:
City	:	PALM DESERT
State	:	CA
Zip	:	92211-6078
Country	:	US
Telephone Number	:	412-720-4789
Fax Number	:

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

Provider Enumeration Date	:	05/13/2014
Last Update Date	:	11/21/2025

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