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General NPI Number Information
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NPI Number | 1760335186
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Entity Type | Organization
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Legal Business Name | PONTE VEDRA BEHAVIORAL HEALTH LLC
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Dates
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Enumeration Date | 02/16/2026
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Last Update Date | 02/16/2026
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Provider Practice Location Address
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Address Line | 90 FORT WADE RD STE 100
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City | PONTE VEDRA
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State | FL
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Zip | 32081-5114
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Country | US
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Telephone | 571-398-1908
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Fax | 386-800-3358
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Provider Business Mailing Address
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Address Line | 252 CAIDEN DR
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City | PONTE VEDRA
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State | FL
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Zip | 32081-1101
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Country | US
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Telephone | 571-398-1908
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Fax | 386-800-3358
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Authorized Official
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Title or Position | MANAGING MEMBER/CLINICAL DIRECTOR
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Name | MRS. BUSAYO MARY ENIKANOSELU STELBEN
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Credential | BCBA
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Telephone | 571-398-1908
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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 |
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License Number State |
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