Individual
AYANTU KAYO SHANKULIE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1001 E 77TH ST APT 305, RICHFIELD, MN 55423-4551
(651) 421-5221
Mailing address
111 KELLOGG BLVD E APT 1514, SAINT PAUL, MN 55101-1214
(651) 421-5221
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
04/26/2024
Last updated
04/26/2024
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