Healthcare Provider Details

I. General information

NPI: 1275496101
Provider Name (Legal Business Name): NICHOLAS ANDREW SALES
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7451 WILES RD STE 107
CORAL SPRINGS FL
33067-2040
US

IV. Provider business mailing address

5411 SW 13TH CT
NORTH LAUDERDALE FL
33068-4089
US

V. Phone/Fax

Practice location:
  • Phone: 954-893-2442
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: