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General NPI Number Information
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NPI Number | 1023452265
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Entity Type | Individual
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Provider Name | YAISY COSTALES SADE MS, BCBA
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Gender | Female
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Dates
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Enumeration Date | 04/18/2013
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Last Update Date | 07/15/2024
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Provider Practice Location Address
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Address Line | 2730 CLYDO RD STE 4
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City | JACKSONVILLE
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State | FL
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Zip | 32207-7964
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Country | US
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Telephone | 904-666-5147
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Fax | 855-226-6396
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Provider Business Mailing Address
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Address Line | 6014 WATEREDGE LN FL 32211
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City | JACKSONVILLE
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State | FL
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Zip | 32211-7540
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Country | US
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Telephone | 786-525-3114
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Fax | 855-226-6396
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-14-17786
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License Number State | FL
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