MEDICARE: SANDRA M PINZON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1053846709
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANDRA M PINZON

Provider Business Mailing Address
First Line	:	579 BOHANNON BLVD
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32824-5906
Country	:	US
Telephone Number	:	407-591-9531
Fax Number	:

Provider Business Practice Location Address
First Line	:	2807 EDGEWATER DR
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32804-4411
Country	:	US
Telephone Number	:	407-601-3553
Fax Number	:	407-613-5600

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/01/2017
Last Update Date	:	05/01/2017

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Directions to “ SANDRA M PINZON ” Practice Location

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