MEDICARE: EILEEN SANAXAY 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	103K00000X	Behavior Analyst	8592	TX

General Provider Information

NPI Number	:	1154210128
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EILEEN SANAXAY BCBA

Provider Business Mailing Address
First Line	:	14115 N HWY 183 APT 1212
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78717-6186
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2500 W WILLIAM CANNON DR STE 605
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78745-5320
Country	:	US
Telephone Number	:	512-986-7625
Fax Number	:	281-254-7897

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

Provider Enumeration Date	:	07/02/2025
Last Update Date	:	07/02/2025

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