MEDICARE: EVOLVING BEHAVIORAL SUPPORT- ABA THERAPY

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	:	1528805520
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EVOLVING BEHAVIORAL SUPPORT- ABA THERAPY

Provider Business Mailing Address
First Line	:	725 BATTERY POINTE DR
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32828-6648
Country	:	US
Telephone Number	:	407-733-7608
Fax Number	:

Provider Business Practice Location Address
First Line	:	3801 AVALON PARK EAST BLVD STE 200
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32828-4902
Country	:	US
Telephone Number	:	407-733-7608
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	RAMONA BUDHOO
Credential	:	BCBA
Telephone Number	:	407-733-7608

Provider Enumeration Date	:	07/09/2024
Last Update Date	:	07/09/2024

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