Ismael Mohammed El-Tayuddin
Individual provider Active NPI Behavior Analyst · Broadlands, VA
NPI 1992474761 · NPPES record last updated Sep 7, 2021
Key facts
- NPI
- 1992474761
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Behavior Analyst 103K00000X
- License
- 0133002040 (VA)
- Practice address
- 21576 Iredell Ter
Broadlands, VA 20148-5033 - Phone
- (510) 738-7709
- Fax
- (844) 333-0432
- NPI assigned
- Sep 7, 2021
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0133002040 | VA | MD | Behavioral Analyst |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Analyst | 103K00000X | 0133002040 | VA | Yes |
Addresses
Primary practice location
21576 Iredell Ter
Broadlands, VA 20148-5033
Mailing address
21576 Iredell Ter
Broadlands, VA 20148-5033
Phone (510) 738-7709
Other providers in Broadlands, VA
- Dental Professionals of Virginia, P.C
- Aleena Desai
- Jane Elizabeth Dettra
- Felicity Donato
- Kimberly Edwards
- Empower Chiropractic Loudoun LLC
- Jacquelyn Erb
- Erin Baer LPC PLLC
- Lisa Ernest
- Joel Esslinger
All providers in Broadlands, VA · Behavior Analyst in Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 7, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.