Healthcare Provider Details

I. General information

NPI: 1932854015
Provider Name (Legal Business Name): DEMI DEANN SIVILS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2022
Last Update Date: 12/19/2024
Certification Date: 12/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6953 UNIVERSITY BLVD
WINTER PARK FL
32792-6710
US

IV. Provider business mailing address

300 INTERNATIONAL PKWY STE 200
LAKE MARY FL
32746-5028
US

V. Phone/Fax

Practice location:
  • Phone: 407-543-8356
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-24-78022
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: