Healthcare Provider Details

I. General information

NPI: 1104397587
Provider Name (Legal Business Name): SANTANO DESSIN RBT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2018
Last Update Date: 01/03/2025
Certification Date: 01/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6953 UNIVERSITY BLVD
WINTER PARK FL
32792-6710
US

IV. Provider business mailing address

1160 S SEMORAN BLVD
ORLANDO FL
32807-1461
US

V. Phone/Fax

Practice location:
  • Phone: 407-543-8356
  • Fax: 407-264-6443
Mailing address:
  • Phone: 800-676-5130
  • Fax: 888-959-5753

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-24-78680
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: