MEDICARE: JESSICA FAICHA ESPAILLAT 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	103K00000X	Behavior Analyst	BACB538220	NC

General Provider Information

NPI Number	:	1639811631
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA FAICHA ESPAILLAT BCBA

Provider Business Mailing Address
First Line	:	1308 PENNINGTON PL NW
Second Line	:
City	:	CONCORD
State	:	NC
Zip	:	28027-8071
Country	:	US
Telephone Number	:	321-945-0044
Fax Number	:

Provider Business Practice Location Address
First Line	:	8615 CLIFF CAMERON DR STE 200
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28269-5914
Country	:	US
Telephone Number	:	855-772-8847
Fax Number	:

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

Provider Enumeration Date	:	04/11/2022
Last Update Date	:	01/29/2026

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