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NPI Code Detail

MEDICARE: MADELYN GORDON

MEDICARE: MADELYN GORDON
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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1770291817
Entity Type Code : Individual
Provider Name (Legal Business Name) : MADELYN GORDON
Provider Business Mailing Address
First Line : 544 NEWTOWN RD STE 110
Second Line :
City : VIRGINIA BEACH
State : VA
Zip : 23462-5603
Country : US
Telephone Number : 224-206-5001
Fax Number :
Provider Business Practice Location Address
First Line : 544 NEWTOWN RD STE 110
Second Line :
City : VIRGINIA BEACH
State : VA
Zip : 23462-5603
Country : US
Telephone Number : 224-206-5001
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/08/2022
Last Update Date : 01/28/2026

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Directions to “ MADELYN GORDON ” Practice Location

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