MEDICARE: CHANDA ALBRITTON

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	106E00000X	Assistant Behavior Analyst	A232013APD0049032	FL
2	106S00000X	Behavior Technician		FL
3	106S00000X	Behavior Technician

Other Identifiers

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

General Provider Information

NPI Number	:	1225580376
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHANDA ALBRITTON

Provider Business Mailing Address
First Line	:	300 INTERNATIONAL PKWY STE 200
Second Line	:
City	:	LAKE MARY
State	:	FL
Zip	:	32746-5028
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	12725 RACE TRACK RD
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33626-1314
Country	:	US
Telephone Number	:	813-467-7190
Fax Number	:

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

Provider Enumeration Date	:	10/25/2016
Last Update Date	:	03/13/2020

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Directions to “ CHANDA ALBRITTON ” Practice Location

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