Healthcare Provider Details

I. General information

NPI: 1093503906
Provider Name (Legal Business Name): KEYNI MOYA SARDINAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/29/2025
Last Update Date: 04/29/2025
Certification Date: 04/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16025 SADDLESTRING DR
TAMPA FL
33618-1402
US

IV. Provider business mailing address

16025 SADDLESTRING DR
TAMPA FL
33618-1402
US

V. Phone/Fax

Practice location:
  • Phone: 813-279-3542
  • Fax:
Mailing address:
  • Phone: 813-279-3542
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-25-422674
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: