Cordalius Graham
Behavior Technician in Mount Dora, FL. Individual provider (NPI-1).
NPI number1104550409
StatusActive
Last updated in NPPESJul 12, 2022
Details
- NPI
- 1104550409
- Entity type
- Individual (NPI-1)
- Name
- Cordalius Graham
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- Jul 12, 2022
- Certification date
- Jul 12, 2022
- Last updated
- Jul 12, 2022
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 106S00000X | Behavior Technician | – | – | Yes |
Practice location
121 N Highland StMount Dora, FL 32757-5764
Phone 813-438-6796
Mailing address
1202 Tech Blvd Ste 103Tampa, FL 33619-7863
Is something wrong?
This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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All 285 Behavior Technician providers in Mount Dora · All 974 providers in Mount Dora
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