Healthcare Provider Details

I. General information

NPI: 1043194509
Provider Name (Legal Business Name): PAYTON WIERNIK BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2025
Last Update Date: 07/26/2026
Certification Date: 07/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8188 S JOG RD STE 101
BOYNTON BEACH FL
33472-2952
US

IV. Provider business mailing address

882 JACKSON AVE
WINTER PARK FL
32789-4667
US

V. Phone/Fax

Practice location:
  • Phone: 855-444-5664
  • Fax:
Mailing address:
  • Phone: 407-279-0526
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number795936
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: