Healthcare Provider Details

I. General information

NPI: 1487222949
Provider Name (Legal Business Name): SUNSHINE ABA THERAPY SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2021
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3209 CYPRESS GROVE DR
EUSTIS FL
32736-2503
US

IV. Provider business mailing address

3209 CYPRESS GROVE DR
EUSTIS FL
32736-2503
US

V. Phone/Fax

Practice location:
  • Phone: 407-907-2077
  • Fax:
Mailing address:
  • Phone: 407-670-9047
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: NICOLE WAGNER
Title or Position: OWNER
Credential: BCBA
Phone: 407-670-9047