MEDICARE: JAYMEE ANN SAMBO SIMBULAN BCBA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106E00000X	Assistant Behavior Analyst		FL
2	103K00000X	Behavior Analyst

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1114436029
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAYMEE ANN SAMBO SIMBULAN BCBA

Provider Business Mailing Address
First Line	:	1056 NIN ST
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32835-5135
Country	:	US
Telephone Number	:	407-600-7463
Fax Number	:

Provider Business Practice Location Address
First Line	:	3200 S HIAWASSEE RD STE 203
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32835-6317
Country	:	US
Telephone Number	:	407-600-7463
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/22/2017
Last Update Date	:	03/21/2018

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