Healthcare Provider Details

I. General information

NPI: 1760107197
Provider Name (Legal Business Name): HEISY LEDESMA BCBA/MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2022
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4271 NEPTUNE RD
SAINT CLOUD FL
34769-6744
US

IV. Provider business mailing address

2530 WINSOME WAY
DAVENPORT FL
33896-7307
US

V. Phone/Fax

Practice location:
  • Phone: 407-219-0391
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-22-229445
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-89997
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: