Provider Demographics
NPI:1043562317
Name:MILYKO, ETHAN MICHAEL
Entity Type:Individual
Prefix:MR
First Name:ETHAN
Middle Name:MICHAEL
Last Name:MILYKO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1745 BEARBERRY CIR
Mailing Address - Street 2:APT 301
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33559-8746
Mailing Address - Country:US
Mailing Address - Phone:775-553-8553
Mailing Address - Fax:
Practice Address - Street 1:26837 TANIC DR
Practice Address - Street 2:STE 103
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33544-4613
Practice Address - Country:US
Practice Address - Phone:813-778-5201
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-10
Last Update Date:2012-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst