Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106E00000X | Assistant Behavior Analyst | 0-18-9206 | FL |
N | 106S00000X | Behavior Technician |
NPI | 1104352731 |
---|---|
Provider Name | Melonie Maldonado |
First Address | Melbourne, FL 32901-1900 |
Second Address | Melbourne, FL 32901-1900 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/05/2017 |
Last Update Date | 08/01/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
020780900 | (05) | FL |