MEDICARE: MRS. ANASTASIIA D SKORNIAKOVA RBT

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		FL

General Provider Information

NPI Number	:	1891437190
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ANASTASIIA D SKORNIAKOVA RBT

Provider Business Mailing Address
First Line	:	495 GRAND BLVD STE 206
Second Line	:
City	:	MIRAMAR BEACH
State	:	FL
Zip	:	32550-1897
Country	:	US
Telephone Number	:	850-299-4862
Fax Number	:

Provider Business Practice Location Address
First Line	:	340 SCENIC GULF DR UNIT 7
Second Line	:
City	:	MIRAMAR BEACH
State	:	FL
Zip	:	32550-7022
Country	:	US
Telephone Number	:	850-226-0176
Fax Number	:

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

Provider Enumeration Date	:	04/08/2022
Last Update Date	:	04/08/2022

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