Healthcare Provider Details

I. General information

NPI: 1043122963
Provider Name (Legal Business Name): ANNIE ONDO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/17/2026
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3408 S MANHATTAN AVE STE 2
TAMPA FL
33629-8400
US

IV. Provider business mailing address

9126 FOX SPARROW RD
TAMPA FL
33626-2653
US

V. Phone/Fax

Practice location:
  • Phone: 727-768-1753
  • Fax:
Mailing address:
  • Phone: 727-768-1753
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number1571538
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: