Healthcare Provider Details

I. General information

NPI: 1194309708
Provider Name (Legal Business Name): PEDIATRIC ANALYTICS & SYSTEMATIC SUPPORTS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2021
Last Update Date: 05/10/2021
Certification Date: 05/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7065 WESTPOINTE BLVD STE 307
ORLANDO FL
32835-8758
US

IV. Provider business mailing address

PO BOX 770806
ORLANDO FL
32877-0806
US

V. Phone/Fax

Practice location:
  • Phone: 407-205-7735
  • Fax:
Mailing address:
  • Phone: 407-205-7735
  • 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 Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: REHAN MAIRAJUDDIN
Title or Position: CEO - CLINICAL DIRECTOR
Credential: BCBA
Phone: 407-205-7735