Healthcare Provider Details

I. General information

NPI: 1932908019
Provider Name (Legal Business Name): ANNIKA SHAWANA BENDERS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/11/2025
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 WAYMONT CT STE 122
LAKE MARY FL
32746-3413
US

IV. Provider business mailing address

4540 RAMBLE ROSE CIR APT 210
SANFORD FL
32771-6875
US

V. Phone/Fax

Practice location:
  • Phone: 407-890-8883
  • Fax:
Mailing address:
  • Phone: 407-639-1918
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-25-415738
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: