MEDICARE: CONCORDIA ABA LLC

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	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1104771575
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CONCORDIA ABA LLC

Provider Business Mailing Address
First Line	:	2007 DERBY GLEN DR
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32837-8029
Country	:	US
Telephone Number	:	689-233-8902
Fax Number	:

Provider Business Practice Location Address
First Line	:	2007 DERBY GLEN DR
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32837-8029
Country	:	US
Telephone Number	:	689-233-8902
Fax Number	:

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	MISS SHIRLEY RIDDLE
Credential	:	BCBA
Telephone Number	:	407-318-0772

Provider Enumeration Date	:	03/02/2026
Last Update Date	:	05/20/2026

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