=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548072473
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SUNRAY ABA VA LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/27/2025
-----------------------------------------------------
Last Update Date | 01/27/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7288 HANOVER GREEN DR STE A
-----------------------------------------------------
City | MECHANICSVILLE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23111-1709
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-666-9995
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 317 MONMOUTH AVE STE 209
-----------------------------------------------------
City | LAKEWOOD
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08701-3209
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-666-9995
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR OF OPERATIONS
-----------------------------------------------------
Name | MR. GEORGE SCHLEIDER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 732-666-9995
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103K00000X
-----------------------------------------------------
Taxonomy Name | Behavior Analyst
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------