Healthcare Provider Details

I. General information

NPI: 1306598560
Provider Name (Legal Business Name): SYDNEY K KOERNER BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2022
Last Update Date: 03/09/2026
Certification Date: 03/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7778 SW JACK JAMES DR
STUART FL
34997-7249
US

IV. Provider business mailing address

2701 MICHIGAN AVE STE J
KISSIMMEE FL
34744-1214
US

V. Phone/Fax

Practice location:
  • Phone: 561-371-0605
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-22-199846
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: