Healthcare Provider Details

I. General information

NPI: 1922361682
Provider Name (Legal Business Name): SANDRA TRIGLIA MS.ED., BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2012
Last Update Date: 10/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12356 MOSS LAKE LOOP
TRINITY FL
34655-2328
US

IV. Provider business mailing address

12356 MOSS LAKE LOOP
TRINITY FL
34655-2328
US

V. Phone/Fax

Practice location:
  • Phone: 727-597-2335
  • Fax:
Mailing address:
  • Phone: 727-597-2335
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-07-3212
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: