MEDICARE: SANDRA DESILMA

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	106S00000X	Behavior Technician	RBT-20-142361	FL
2	101YM0800X	Mental Health Counselor		FL

General Provider Information

NPI Number	:	1376205955
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANDRA DESILMA

Provider Business Mailing Address
First Line	:	707 MENDHAM BLVD
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32825-3205
Country	:	US
Telephone Number	:	407-795-3682
Fax Number	:

Provider Business Practice Location Address
First Line	:	707 MENDHAM BLVD
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32825-3205
Country	:	US
Telephone Number	:	407-795-3682
Fax Number	:

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

Provider Enumeration Date	:	10/11/2021
Last Update Date	:	01/26/2026

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Directions to “ SANDRA DESILMA ” Practice Location

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