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Individual

KHADEJHA KEIONA BANTON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
6 N MAIN ST STE 110, FAIRPORT, NY 14450-1581
(585) 377-6590
Mailing address
6 N MAIN ST STE 110, FAIRPORT, NY 14450-1581
(585) 377-6590

Taxonomy

Speciality
Code
Description
License number
State
106E00000X
Assistant Behavior Analyst
Primary

Other

Enumeration date
03/13/2019
Last updated
03/13/2019
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