MEDICARE: PHOENIX FREEDOM ACADEMY

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	:	1699582684
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHOENIX FREEDOM ACADEMY

Provider Business Mailing Address
First Line	:	1707 TERRA COTA CT
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32825-8904
Country	:	US
Telephone Number	:	407-232-2726
Fax Number	:

Provider Business Practice Location Address
First Line	:	1707 TERRA COTA CT
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32825-8904
Country	:	US
Telephone Number	:	407-232-2726
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. QUORNELIA HYPOLITE
Credential	:	BCBA-D
Telephone Number	:	407-232-2726

Provider Enumeration Date	:	12/13/2024
Last Update Date	:	01/30/2025

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Directions to “PHOENIX FREEDOM ACADEMY ” Practice Location

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