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NPI Code Detail

MEDICARE: KELLY B CALDARAS M.S., BCBA

MEDICARE: KELLY B CALDARAS M.S., BCBA
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
1390200000XStudent in an Organized Health Care Education/Training Program
2103K00000XBehavior AnalystFL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1225477326
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELLY B CALDARAS M.S., BCBA
Provider Business Mailing Address
First Line : 175 MIDDLE ST UNIT 1201
Second Line :
City : LAKE MARY
State : FL
Zip : 32746-3625
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 514 S HUNT CLUB BLVD
Second Line :
City : APOPKA
State : FL
Zip : 32703-4948
Country : US
Telephone Number : 407-613-2335
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/21/2013
Last Update Date : 02/11/2019

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