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NPI Code Detail

MEDICARE: ELLEN G. SUSTEK BCBA

MEDICARE: ELLEN G. SUSTEK 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
1103K00000XBehavior Analyst01-23-64565

Other Identifiers

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

General Provider Information

NPI Number : 1386945855
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELLEN G. SUSTEK BCBA
Provider Business Mailing Address
First Line : 2707 WALDEN WOODS DR
Second Line :
City : PLANT CITY
State : FL
Zip : 33566-7107
Country : US
Telephone Number : 813-300-8274
Fax Number :
Provider Business Practice Location Address
First Line : 2707 WALDEN WOODS DR
Second Line :
City : PLANT CITY
State : FL
Zip : 33566-7107
Country : US
Telephone Number : 813-300-8274
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/15/2010
Last Update Date : 07/01/2024

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