Healthcare Provider Details

I. General information

NPI: 1982299095
Provider Name (Legal Business Name): NATHALY WICHMAN BCABA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/02/2021
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9750 JAMAICA DR
CUTLER BAY FL
33189-1753
US

IV. Provider business mailing address

9750 JAMAICA DR
CUTLER BAY FL
33189-1753
US

V. Phone/Fax

Practice location:
  • Phone: 305-781-0988
  • Fax:
Mailing address:
  • Phone: 305-781-0988
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number0-25-16241
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: