Healthcare Provider Details

I. General information

NPI: 1447845896
Provider Name (Legal Business Name): NAHEELAH S WALLACE RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/08/2021
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 N MILITARY TRL STE 304
BOCA RATON FL
33431-6324
US

IV. Provider business mailing address

6678 CONCH CT
BOYNTON BEACH FL
33437-3651
US

V. Phone/Fax

Practice location:
  • Phone: 561-421-5111
  • Fax:
Mailing address:
  • Phone: 772-204-6457
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-2835814
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number21-154350
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: