Healthcare Provider Details

I. General information

NPI: 1992453021
Provider Name (Legal Business Name): SARAH GRASSI MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2022
Last Update Date: 08/08/2024
Certification Date: 08/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1342 SE 46TH LN
CAPE CORAL FL
33904-8617
US

IV. Provider business mailing address

5050 TAMIAMI TRL N
NAPLES FL
34103-2853
US

V. Phone/Fax

Practice location:
  • Phone: 239-961-3032
  • Fax:
Mailing address:
  • Phone: 239-351-0675
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-24-74790
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: