MEDICARE: MARIA TERESELNA GANTAN

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		VA

General Provider Information

NPI Number	:	1700743051
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIA TERESELNA GANTAN

Provider Business Mailing Address
First Line	:	623 SEA TURTLE WAY
Second Line	:
City	:	NEWPORT NEWS
State	:	VA
Zip	:	23601-1755
Country	:	US
Telephone Number	:	757-869-0625
Fax Number	:

Provider Business Practice Location Address
First Line	:	623 SEA TURTLE WAY
Second Line	:
City	:	NEWPORT NEWS
State	:	VA
Zip	:	23601-1755
Country	:	US
Telephone Number	:	757-869-0625
Fax Number	:

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

Provider Enumeration Date	:	01/08/2026
Last Update Date	:	01/08/2026

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Directions to “ MARIA TERESELNA GANTAN ” Practice Location

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