MEDICARE: NYTASIA INGRAM 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

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	:	1366009128
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NYTASIA INGRAM BCBA

Provider Business Mailing Address
First Line	:	443 W PINE ST
Second Line	:
City	:	ARCADIA
State	:	FL
Zip	:	34266-3741
Country	:	US
Telephone Number	:	321-704-6116
Fax Number	:

Provider Business Practice Location Address
First Line	:	5833 S GOLDENROD RD # 1020
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32822-8777
Country	:	US
Telephone Number	:	321-704-6119
Fax Number	:

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

Provider Enumeration Date	:	05/28/2019
Last Update Date	:	02/15/2026

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