Healthcare Provider Details

I. General information

NPI: 1245685627
Provider Name (Legal Business Name): SOUTH FLORIDA AUTISM CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2016
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18305 NW 75TH PL
HIALEAH FL
33015-2957
US

IV. Provider business mailing address

3751 W 108TH ST
HIALEAH FL
33018-2218
US

V. Phone/Fax

Practice location:
  • Phone: 305-823-2700
  • Fax: 305-823-2705
Mailing address:
  • Phone: 305-823-2700
  • Fax: 305-823-2705

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. TAMARA LATOYA MOODIE
Title or Position: EXECUTIVE DIRECTOR
Credential: PH. D.
Phone: 305-823-2700