Healthcare Provider Details

I. General information

NPI: 1588359616
Provider Name (Legal Business Name): SAVANNAH KAY RILEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SAVANNAH K HACKETT

II. Dates (important events)

Enumeration Date: 04/05/2023
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6976 PROFESSIONAL PKWY
LAKEWOOD RANCH FL
34240-8414
US

IV. Provider business mailing address

300 INTERNATIONAL PKWY STE 200
LAKE MARY FL
32746-5028
US

V. Phone/Fax

Practice location:
  • Phone: 970-201-1351
  • Fax:
Mailing address:
  • Phone: 970-424-5152
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: