Healthcare Provider Details

I. General information

NPI: 1346166220
Provider Name (Legal Business Name): SARAH ROSE CLOSSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2026
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 E MELBOURNE AVE STE 103B
MELBOURNE FL
32901-5970
US

IV. Provider business mailing address

2520 BROOKSHIRE CIR
WEST MELBOURNE FL
32904-6638
US

V. Phone/Fax

Practice location:
  • Phone: 321-677-2222
  • Fax:
Mailing address:
  • Phone: 321-989-8280
  • 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:
Title or Position:
Credential:
Phone: