MEDICARE: MARSHALA AKEIBA PATTERSON

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	:	1962284679
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARSHALA AKEIBA PATTERSON

Provider Business Mailing Address
First Line	:	13650 NW 8TH ST STE 109
Second Line	:
City	:	SUNRISE
State	:	FL
Zip	:	33325-6239
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3631 NW 30TH PL APT 306
Second Line	:
City	:	LAUD LAKES
State	:	FL
Zip	:	33311-8368
Country	:	US
Telephone Number	:	347-824-4001
Fax Number	:

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

Provider Enumeration Date	:	10/17/2023
Last Update Date	:	10/17/2023

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