Healthcare Provider Details

I. General information

NPI: 1164386710
Provider Name (Legal Business Name): PATHLIGHT BEHAVIORAL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2025
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1478 ASHDOWN CT
SANFORD FL
32771-8081
US

IV. Provider business mailing address

479 MONTGOMERY PL
ALTAMONTE SPRINGS FL
32714-3100
US

V. Phone/Fax

Practice location:
  • Phone: 407-942-8294
  • Fax: 407-942-8292
Mailing address:
  • Phone: 407-942-8294
  • Fax: 407-942-8292

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: NISHA ARORA
Title or Position: DIRECTOR
Credential: BCBA
Phone: 407-942-8294