MEDICARE: RAWON SAMMOUR 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
1	103K00000X	Behavior Analyst	1-26-87938	FL

General Provider Information

NPI Number	:	1346993383
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAWON SAMMOUR BCBA

Provider Business Mailing Address
First Line	:	8237 VICELA DR
Second Line	:
City	:	SARASOTA
State	:	FL
Zip	:	34240-1462
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2500 BOBCAT VILLAGE CENTER RD UNIT G
Second Line	:
City	:	NORTH PORT
State	:	FL
Zip	:	34288-8476
Country	:	US
Telephone Number	:	800-210-0814
Fax Number	:

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

Provider Enumeration Date	:	01/31/2022
Last Update Date	:	02/26/2026

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