Healthcare Provider Details

I. General information

NPI: 1114718731
Provider Name (Legal Business Name): AMANI PATH ABA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2025
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1206 BOWMAN ST
CLERMONT FL
34711-3144
US

IV. Provider business mailing address

8220 MATISSE ST APT 5310
CHAMPIONS GATE FL
33896-8385
US

V. Phone/Fax

Practice location:
  • Phone: 863-900-2142
  • Fax: 863-204-6123
Mailing address:
  • Phone: 352-431-7836
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ORQUIDEA FORTUNA
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 352-431-7836