Healthcare Provider Details

I. General information

NPI: 1720997588
Provider Name (Legal Business Name): HANNAH LEA ANDERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2135 W STATE ROAD 434
LONGWOOD FL
32779-4983
US

IV. Provider business mailing address

587 E STATE ROAD 434 UNIT 3033
LONGWOOD FL
32750-5256
US

V. Phone/Fax

Practice location:
  • Phone: 407-789-2673
  • Fax:
Mailing address:
  • Phone: 407-789-2673
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberBACB2729193
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: