MEDICARE: MYLA DESHAWN STENNIS

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	S352619139002	MI

General Provider Information

NPI Number	:	1992632707
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MYLA DESHAWN STENNIS

Provider Business Mailing Address
First Line	:	811 S 14TH ST
Second Line	:
City	:	SAGINAW
State	:	MI
Zip	:	48601-2210
Country	:	US
Telephone Number	:	989-401-2244
Fax Number	:

Provider Business Practice Location Address
First Line	:	811 S 14TH ST
Second Line	:
City	:	SAGINAW
State	:	MI
Zip	:	48601-2210
Country	:	US
Telephone Number	:	989-401-2244
Fax Number	:

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

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

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