MEDICARE: MAYULY MORENO

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	1534452	FL

General Provider Information

NPI Number	:	1942133228
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAYULY MORENO

Provider Business Mailing Address
First Line	:	1266 33RD AVE SW
Second Line	:
City	:	VERO BEACH
State	:	FL
Zip	:	32968-5050
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1266 33RD AVE SW
Second Line	:
City	:	VERO BEACH
State	:	FL
Zip	:	32968-5050
Country	:	US
Telephone Number	:	772-559-9062
Fax Number	:

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

Provider Enumeration Date	:	06/05/2026
Last Update Date	:	06/05/2026

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