MEDICARE: SAKURA BEHAVIOR SYSTEMS

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	:	1548115090
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAKURA BEHAVIOR SYSTEMS

Provider Business Mailing Address
First Line	:	5833 S GOLDENROD RD # 1020
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32822-8777
Country	:	US
Telephone Number	:	321-704-6119
Fax Number	:

Provider Business Practice Location Address
First Line	:	5833 S GOLDENROD RD # 1020
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32822-8777
Country	:	US
Telephone Number	:	321-704-6119
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	NYTASIA INGRAM
Credential	:	BCBA
Telephone Number	:	321-704-6119

Provider Enumeration Date	:	03/02/2026
Last Update Date	:	03/02/2026

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