Provider Demographics
NPI:1992501993
Name:MEABE, MAITEDER
Entity type:Individual
Prefix:
First Name:MAITEDER
Middle Name:
Last Name:MEABE
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 1:5305 SUMMERLIN RD APT 14
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33919-7616
Mailing Address - Country:US
Mailing Address - Phone:786-655-2816
Mailing Address - Fax:
Practice Address - Street 1:5305 SUMMERLIN RD APT 14
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33919-7616
Practice Address - Country:US
Practice Address - Phone:786-655-2816
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-20
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician