MEDICARE: SARAH ROLDAN PEDEN MS, 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	390200000X	Student in an Organized Health Care Education/Training Program		FL
2	103K00000X	Behavior Analyst		FL

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	:	1538563796
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH ROLDAN PEDEN MS, BCBA

Provider Business Mailing Address
First Line	:	13086 83RD LN N
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33412-2671
Country	:	US
Telephone Number	:	305-796-7342
Fax Number	:

Provider Business Practice Location Address
First Line	:	2115 10TH AVE N
Second Line	:
City	:	LAKE WORTH BEACH
State	:	FL
Zip	:	33461-3345
Country	:	US
Telephone Number	:	561-506-3665
Fax Number	:

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

Provider Enumeration Date	:	10/17/2014
Last Update Date	:	07/03/2024

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