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General NPI Number Information
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NPI Number | 1194309708
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Entity Type | Organization
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Legal Business Name | PEDIATRIC ANALYTICS & SYSTEMATIC SUPPORTS INC
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Dates
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Enumeration Date | 05/10/2021
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Last Update Date | 05/10/2021
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Provider Practice Location Address
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Address Line | 7065 WESTPOINTE BLVD STE 307
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City | ORLANDO
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State | FL
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Zip | 32835-8758
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Country | US
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Telephone | 407-205-7735
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 770806
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City | ORLANDO
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State | FL
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Zip | 32877-0806
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Country | US
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Telephone | 407-205-7735
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Fax |
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Authorized Official
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Title or Position | CEO - CLINICAL DIRECTOR
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Name | REHAN MAIRAJUDDIN
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Credential | BCBA
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Telephone | 407-205-7735
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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