MEDICARE: TRISTAN PAPALLO

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

General Provider Information

NPI Number	:	1841881901
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRISTAN PAPALLO

Provider Business Mailing Address
First Line	:	27777 INKSTER RD STE 100
Second Line	:
City	:	FARMINGTON HILLS
State	:	MI
Zip	:	48334-5312
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2000 RIVEREDGE PKWY STE 885
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30328-4674
Country	:	US
Telephone Number	:	248-299-0030
Fax Number	:

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

Provider Enumeration Date	:	02/01/2021
Last Update Date	:	02/01/2021

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Directions to “ TRISTAN PAPALLO ” Practice Location

Language	Start Address	Practice Location

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