Healthcare Provider Details

I. General information

NPI: 1720445521
Provider Name (Legal Business Name): SHARAYAH TAI BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/25/2016
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 NW 76TH DR
GAINESVILLE FL
32607-6668
US

IV. Provider business mailing address

250 NW 76TH DR
GAINESVILLE FL
32607-6668
US

V. Phone/Fax

Practice location:
  • Phone: 352-505-6363
  • Fax: 352-505-6383
Mailing address:
  • Phone: 352-505-6363
  • Fax: 352-505-6383

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: