Healthcare Provider Details

I. General information

NPI: 1205627379
Provider Name (Legal Business Name): KIHARA WATSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2025
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

419 S PARK AVE
SANFORD FL
32771-1933
US

IV. Provider business mailing address

5185 LOMA VISTA CIR
OVIEDO FL
32765-6686
US

V. Phone/Fax

Practice location:
  • Phone: 401-368-0268
  • Fax:
Mailing address:
  • Phone: 954-839-4374
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: