Healthcare Provider Details

I. General information

NPI: 1366331076
Provider Name (Legal Business Name): NICHOLAS SANABRIA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2025
Last Update Date: 06/30/2025
Certification Date: 06/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28410 BONITA CROSSINGS BLVD UNIT 150
BONITA SPRINGS FL
34135-3217
US

IV. Provider business mailing address

18336 HAWTHORNE RD
FORT MYERS FL
33967-3275
US

V. Phone/Fax

Practice location:
  • Phone: 239-451-7163
  • Fax: 239-310-2045
Mailing address:
  • Phone: 239-826-5438
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-25-449280
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: