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NPI Code Detail

MEDICARE: BREANNA LEE GASTALDI

MEDICARE: BREANNA LEE GASTALDI
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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1992280267
Entity Type Code : Individual
Provider Name (Legal Business Name) : BREANNA LEE GASTALDI
Provider Business Mailing Address
First Line : 2317 24TH AVE E
Second Line :
City : SEATTLE
State : WA
Zip : 98112-2606
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2317 24TH AVE E
Second Line :
City : SEATTLE
State : WA
Zip : 98112-2606
Country : US
Telephone Number : 206-618-3120
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/02/2018
Last Update Date : 10/02/2018

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Directions to “ BREANNA LEE GASTALDI ” Practice Location

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