Healthcare Provider Details

I. General information

NPI: 1356212021
Provider Name (Legal Business Name): ALL LOVE ONE HEART AUTISM LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2025
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1710 E TIFFANY DR STE 212
MANGONIA PARK FL
33407-3242
US

IV. Provider business mailing address

1710 E TIFFANY DR STE 212
MANGONIA PARK FL
33407-3242
US

V. Phone/Fax

Practice location:
  • Phone: 754-236-2793
  • Fax:
Mailing address:
  • Phone: 754-236-2793
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: MISS NASTASSIA JERUSHA FRIDAY
Title or Position: CEO
Credential: BCBA
Phone: 754-236-2793