Healthcare Provider Details

I. General information

NPI: 1568263176
Provider Name (Legal Business Name): AMAYA SIMPSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2025
Last Update Date: 03/20/2025
Certification Date: 03/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4015 CRESCENT PARK DR
RIVERVIEW FL
33578-3605
US

IV. Provider business mailing address

13030 BRIDLEFORD DR
GIBSONTON FL
33534-3934
US

V. Phone/Fax

Practice location:
  • Phone: 813-492-8310
  • Fax:
Mailing address:
  • Phone: 656-207-4816
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberBACB877967
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: