Individual
TYKIA DUDLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
225 BROADHOLLOW RD STE 402, MELVILLE, NY 11747-4899
(631) 385-7780
(631) 385-7795
Mailing address
13445 166TH PL APT 13B, JAMAICA, NY 11434-3807
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
06/19/2019
Last updated
06/19/2019
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