Healthcare Provider Details

I. General information

NPI: 1063090041
Provider Name (Legal Business Name): AYLIENE LOVELACE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2021
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8395 W OAKLAND PARK BLVD
SUNRISE FL
33351-7301
US

IV. Provider business mailing address

16318 E PIMLICO DR
LOXAHATCHEE FL
33470-4025
US

V. Phone/Fax

Practice location:
  • Phone: 305-951-8352
  • Fax:
Mailing address:
  • Phone: 305-951-8352
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-90159
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: