MEDICARE: MANDY MURRAY 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	1-15-20120	FL

General Provider Information

NPI Number	:	1366793598
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MANDY MURRAY BCBA

Provider Business Mailing Address
First Line	:	6289 PARADISE ISLAND CT
Second Line	:
City	:	PORT ORANGE
State	:	FL
Zip	:	32128-6962
Country	:	US
Telephone Number	:	386-244-7885
Fax Number	:	270-203-0587

Provider Business Practice Location Address
First Line	:	6289 PARADISE ISLAND CT
Second Line	:
City	:	PORT ORANGE
State	:	FL
Zip	:	32128-6962
Country	:	US
Telephone Number	:	407-619-5570
Fax Number	:

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

Provider Enumeration Date	:	09/27/2012
Last Update Date	:	10/09/2025

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