MEDICARE: MALYNEE ARIKA SACKDAVONE

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		NV

General Provider Information

NPI Number	:	1679423297
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MALYNEE ARIKA SACKDAVONE

Provider Business Mailing Address
First Line	:	5937 BERRY HILL LN
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89031-1749
Country	:	US
Telephone Number	:	702-825-1010
Fax Number	:

Provider Business Practice Location Address
First Line	:	4348 W CHEYENNE AVE
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89032-2484
Country	:	US
Telephone Number	:	702-825-1010
Fax Number	:

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

Provider Enumeration Date	:	02/02/2026
Last Update Date	:	02/02/2026

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Directions to “ MALYNEE ARIKA SACKDAVONE ” Practice Location

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