Healthcare Provider Details

I. General information

NPI: 1508415050
Provider Name (Legal Business Name): SANDI CAMPBELL RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2019
Last Update Date: 06/02/2022
Certification Date: 06/02/2022
Deactivation Date: 09/08/2019
Reactivation Date: 09/18/2019

III. Provider practice location address

13195 SW 134TH ST STE 201
MIAMI FL
33186-4585
US

IV. Provider business mailing address

6941 SW 10TH ST
PEMBROKE PINES FL
33023-1634
US

V. Phone/Fax

Practice location:
  • Phone: 786-206-6500
  • Fax:
Mailing address:
  • Phone: 305-720-5908
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberRBT-19-97897
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: