Healthcare Provider Details

I. General information

NPI: 1144114240
Provider Name (Legal Business Name): AMBER ALIYAH THOMPSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2025
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 S LAKE DESTINY RD
MAITLAND FL
32751-7226
US

IV. Provider business mailing address

6056 SAND PINES ESTATES BLVD
ORLANDO FL
32819-7760
US

V. Phone/Fax

Practice location:
  • Phone: 407-647-6555
  • Fax:
Mailing address:
  • Phone: 954-695-6007
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: