Healthcare Provider Details

I. General information

NPI: 1033053921
Provider Name (Legal Business Name): BLUE SKY ABA CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2026
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

479 CALABRIA AVE SE
PALM BAY FL
32909-4002
US

IV. Provider business mailing address

479 CALABRIA AVE SE
PALM BAY FL
32909-4002
US

V. Phone/Fax

Practice location:
  • Phone: 321-361-7505
  • Fax: 321-244-1115
Mailing address:
  • Phone: 321-361-7505
  • Fax: 321-244-1115

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: MARIA D BORRAJO
Title or Position: OWNER
Credential:
Phone: 305-772-1652