Healthcare Provider Details

I. General information

NPI: 1598200461
Provider Name (Legal Business Name): CRISTINA AMADOR COSTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/30/2016
Last Update Date: 06/27/2025
Certification Date: 06/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6800 PARAGON PL STE 200
RICHMOND VA
23230-1652
US

IV. Provider business mailing address

12327 BEACONTREE WAY
ORLANDO FL
32837-6510
US

V. Phone/Fax

Practice location:
  • Phone: 804-562-9997
  • Fax:
Mailing address:
  • Phone: 407-839-9535
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number0134000612
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: