Healthcare Provider Details

I. General information

NPI: 1568370088
Provider Name (Legal Business Name): ALEXANDRIA NICOLE PERRY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2026
Last Update Date: 08/28/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5959 LAKE ELLENOR DR
ORLANDO FL
32809-4633
US

IV. Provider business mailing address

6900 PIAZZA GRANDE AVE. BUILDING 6 APT 209
ORLANDO FL
32835
US

V. Phone/Fax

Practice location:
  • Phone: 321-972-4039
  • Fax:
Mailing address:
  • Phone: 561-402-0694
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-26-505724
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: