Healthcare Provider Details

I. General information

NPI: 1407620487
Provider Name (Legal Business Name): LASHAUNDA PHAM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2023
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 S DOUGLAS RD STE 230
CORAL GABLES FL
33134-4108
US

IV. Provider business mailing address

3916 SCOTSBORO CT
ORLANDO FL
32839-5701
US

V. Phone/Fax

Practice location:
  • Phone: 844-244-1818
  • Fax: 844-854-1116
Mailing address:
  • Phone: 844-244-1818
  • Fax: 844-854-1116

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: