=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770361826
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | YANNI MICHELLE SANTAMARIA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/19/2023
-----------------------------------------------------
Last Update Date | 09/19/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8001 SW 36TH ST STE 9
-----------------------------------------------------
City | DAVIE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33328-1915
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-577-7790
-----------------------------------------------------
Fax | 954-577-7780
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5404 NW 192ND LN
-----------------------------------------------------
City | MIAMI GARDENS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33055-1618
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-308-3268
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106S00000X
-----------------------------------------------------
Taxonomy Name | Behavior Technician
-----------------------------------------------------
License Number | RBT-23-296090
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------