Healthcare Provider Details

I. General information

NPI: 1356975205
Provider Name (Legal Business Name): ANGELA VACHON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2020
Last Update Date: 08/26/2025
Certification Date: 08/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7724 BIRCHWOOD DR
PORT RICHEY FL
34668-2211
US

IV. Provider business mailing address

7724 BIRCHWOOD DR
PORT RICHEY FL
34668-2211
US

V. Phone/Fax

Practice location:
  • Phone: 727-777-8131
  • Fax:
Mailing address:
  • Phone: 727-777-8131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number0-25-16405
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: