Healthcare Provider Details

I. General information

NPI: 1538950829
Provider Name (Legal Business Name): MAYA ANDRICKA SAINT-VIL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2025
Last Update Date: 05/15/2025
Certification Date: 05/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3829 HOLLYWOOD BLVD STE D
HOLLYWOOD FL
33021-6790
US

IV. Provider business mailing address

3829 HOLLYWOOD BLVD STE D
HOLLYWOOD FL
33021-6790
US

V. Phone/Fax

Practice location:
  • Phone: 954-367-3600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-25-419211
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: