Idalie Marcellus, CERTIFICATE

Primary specialty

Behavior TechnicianTaxonomy code 106S00000X

License

M624-400-86-507-0 Issued in FL

Practice address

2904 NW 48TH St
Tamarac, FL 33309-3510

Phone

(786) 665-0518

NPI assigned

Sep 5, 2020

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1599264000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1671408000000",
    "number": "1659985703",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "330 NE 116TH ST",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331616622",
            "telephone_number": "786-665-0518"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2904 NW 48TH ST",
            "city": "TAMARAC",
            "state": "FL",
            "postal_code": "333093510",
            "telephone_number": "786-665-0518"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARCELLUS",
        "first_name": "IDALIE",
        "credential": "CERTIFICATE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-09-05",
        "last_updated": "2022-12-19",
        "certification_date": "2022-12-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "251C00000X",
            "taxonomy_group": "",
            "desc": "Day Training, Developmentally Disabled Services",
            "state": "FL",
            "license": "M624-400-86-507-0",
            "primary": false
        },
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": "FL",
            "license": "M624-400-86-507-0",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Shobha Keragodu Marigowda, APRN

• Behavior Technician in Tamarac, FL
• Providers in Tamarac, FL by specialty
• Behavior Technician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.