Healthcare Provider Details

I. General information

NPI: 1184552028
Provider Name (Legal Business Name): SADIA ALI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

2377 MARKET DR
FLEMING ISLAND FL
32003-4326
US

IV. Provider business mailing address

1395 LITTLE HERON PL
GREEN COVE SPRINGS FL
32043-3879
US

V. Phone/Fax

Practice location:
  • Phone: 904-579-4779
  • 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: