Healthcare Provider Details

I. General information

NPI: 1134060494
Provider Name (Legal Business Name): SANDRA DE FAZIO RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12202 ROYAL PALM BLVD
CORAL SPRINGS FL
33065-3276
US

IV. Provider business mailing address

12202 ROYAL PALM BLVD
CORAL SPRINGS FL
33065-3276
US

V. Phone/Fax

Practice location:
  • Phone: 786-806-3138
  • Fax: 786-806-3138
Mailing address:
  • Phone: 786-806-3138
  • Fax: 786-806-3138

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-26-523905
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: