Healthcare Provider Details

I. General information

NPI: 1063030039
Provider Name (Legal Business Name): ABRAHAM ANTONIO SARDINAS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2020
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3261 NW 213TH TER
MIAMI GARDENS FL
33056-1032
US

IV. Provider business mailing address

3261 NW 213TH TER
MIAMI GARDENS FL
33056-1032
US

V. Phone/Fax

Practice location:
  • Phone: 786-286-7656
  • Fax:
Mailing address:
  • Phone: 786-286-7656
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-2853222
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number0-24-15457
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-20-110321
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: