MEDICARE: SUNTREE BEHAVIOR ANALYSIS, LLC

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

General Provider Information

NPI Number	:	1215605597
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUNTREE BEHAVIOR ANALYSIS, LLC

Provider Business Mailing Address
First Line	:	1461 HOLLAND ST
Second Line	:
City	:	MELBOURNE
State	:	FL
Zip	:	32935-2824
Country	:	US
Telephone Number	:	321-233-5522
Fax Number	:

Provider Business Practice Location Address
First Line	:	1461 HOLLAND ST
Second Line	:
City	:	MELBOURNE
State	:	FL
Zip	:	32935-2824
Country	:	US
Telephone Number	:	321-233-5522
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	VANESSA R. VALDENEGRO
Credential	:	BCBA
Telephone Number	:	321-233-5522

Provider Enumeration Date	:	09/01/2021
Last Update Date	:	09/01/2021

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