Healthcare Provider Details

I. General information

NPI: 1679301204
Provider Name (Legal Business Name): SANTAMORE NICOLE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2024
Last Update Date: 05/08/2025
Certification Date: 05/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2226 SARNO RD STE 100
MELBOURNE FL
32935-3087
US

IV. Provider business mailing address

3061 DAGGET AVE SE
PALM BAY FL
32909-8113
US

V. Phone/Fax

Practice location:
  • Phone: 321-408-6393
  • Fax:
Mailing address:
  • Phone: 207-206-2743
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name: MS. NICOLE SANTAMORE
Title or Position: OWNER
Credential: BCBA
Phone: 321-408-6393