Healthcare Provider Details

I. General information

NPI: 1669157533
Provider Name (Legal Business Name): NICOLE SANCHEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2023
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 S LAKE DESTINY RD STE 350
MAITLAND FL
32751-7222
US

IV. Provider business mailing address

1681 BIG OAK LN
KISSIMMEE FL
34746-3805
US

V. Phone/Fax

Practice location:
  • Phone: 407-618-0493
  • Fax:
Mailing address:
  • Phone:
  • 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: