MEDICARE: EMILY PAGE BALYEAT

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	:	1760352884
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY PAGE BALYEAT

Provider Business Mailing Address
First Line	:	3450 BERKMAR DR STE 111
Second Line	:
City	:	CHARLOTTESVILLE
State	:	VA
Zip	:	22901-8052
Country	:	US
Telephone Number	:	540-738-7720
Fax Number	:

Provider Business Practice Location Address
First Line	:	3450 BERKMAR DR STE 111
Second Line	:
City	:	CHARLOTTESVILLE
State	:	VA
Zip	:	22901-8052
Country	:	US
Telephone Number	:	540-738-7720
Fax Number	:

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

Provider Enumeration Date	:	11/05/2025
Last Update Date	:	11/05/2025

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Directions to “ EMILY PAGE BALYEAT ” Practice Location

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