MEDICARE: I AM DESTINY ACADEMY LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	103K00000X	Behavior Analyst
2	251C00000X	Developmentally Disabled Services Day Training Agency
3	251S00000X	Community/Behavioral Health Agency
4	385HR2060X	Child Intellectual and/or Developmental Disabilities Respite Care
5	251300000X	Local Education Agency (LEA)

General Provider Information

NPI Number	:	1114850047
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	I AM DESTINY ACADEMY LLC

Provider Business Mailing Address
First Line	:	6754 S CARTER RD
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33813-3614
Country	:	US
Telephone Number	:	407-960-8721
Fax Number	:

Provider Business Practice Location Address
First Line	:	6754 S CARTER RD
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33813-3614
Country	:	US
Telephone Number	:	407-960-8721
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	BONITA STAMPER
Credential	:
Telephone Number	:	407-960-8721

Provider Enumeration Date	:	06/08/2026
Last Update Date	:	06/08/2026

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