MEDICARE: AWADIS KHSHVADJIAN

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	103K00000X	Behavior Analyst	8974	TX

General Provider Information

NPI Number	:	1811869076
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AWADIS KHSHVADJIAN

Provider Business Mailing Address
First Line	:	125 E GRUBB DR # 107
Second Line	:
City	:	MESQUITE
State	:	TX
Zip	:	75149-3402
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	125 E GRUBB DR # 107
Second Line	:
City	:	MESQUITE
State	:	TX
Zip	:	75149-3402
Country	:	US
Telephone Number	:	647-633-4466
Fax Number	:

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

Provider Enumeration Date	:	09/18/2025
Last Update Date	:	09/18/2025

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