MEDICARE: ALEXANDRA PAIGE KELLAS BCBA

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	RBT-17-44279	VA
2	103K00000X	Behavior Analyst	1-20-40962	VA

General Provider Information

NPI Number	:	1750896999
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXANDRA PAIGE KELLAS BCBA

Provider Business Mailing Address
First Line	:	118 RAILWAY RD
Second Line	:
City	:	YORKTOWN
State	:	VA
Zip	:	23692-2930
Country	:	US
Telephone Number	:	757-817-0089
Fax Number	:

Provider Business Practice Location Address
First Line	:	12610 PATRICK HENRY DR STE M
Second Line	:
City	:	NEWPORT NEWS
State	:	VA
Zip	:	23602-9538
Country	:	US
Telephone Number	:	757-304-0224
Fax Number	:

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

Provider Enumeration Date	:	12/11/2017
Last Update Date	:	06/16/2025

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