Provider Demographics
NPI:1972372258
Name:ADUAKA, MARYIMELDA
Entity type:Individual
Prefix:
First Name:MARYIMELDA
Middle Name:
Last Name:ADUAKA
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3174 SW 129TH WAY
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33027-5354
Mailing Address - Country:US
Mailing Address - Phone:248-460-3637
Mailing Address - Fax:
Practice Address - Street 1:7762 VENETIAN ST
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33023-2444
Practice Address - Country:US
Practice Address - Phone:248-460-3637
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-27
Last Update Date:2025-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RBT-23-311442106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL122704800Medicaid