Healthcare Provider Details

I. General information

NPI: 1033765268
Provider Name (Legal Business Name): ANDJELA AVRAM BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2019
Last Update Date: 03/10/2020
Certification Date: 03/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

380 SEMORAN COMMERCE PL STE 209
APOPKA FL
32703-4684
US

IV. Provider business mailing address

6230 MORNING MIST LN
ORLANDO FL
32819-6915
US

V. Phone/Fax

Practice location:
  • Phone: 321-368-1087
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-19-39706
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: