MEDICARE: SPROUT APPLIED BEHAVIOR ANALYSIS PLLC

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	:	1841160546
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPROUT APPLIED BEHAVIOR ANALYSIS PLLC

Provider Business Mailing Address
First Line	:	1114 GERARD AVE APT 26
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10452-8851
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1114 GERARD AVE APT 26
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10452-8851
Country	:	US
Telephone Number	:	347-981-4870
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	NANCY RODRIGUEZ
Credential	:
Telephone Number	:	347-981-4870

Provider Enumeration Date	:	11/07/2025
Last Update Date	:	01/15/2026

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