MEDICARE: VANESSA ASHTON KINDY MA 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	222Q00000X	Developmental Therapist
2	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	:	1417378357
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VANESSA ASHTON KINDY MA BCBA

Provider Business Mailing Address
First Line	:	580 HOLBROOK CIR
Second Line	:
City	:	LAKE MARY
State	:	FL
Zip	:	32746-6332
Country	:	US
Telephone Number	:	407-342-4220
Fax Number	:

Provider Business Practice Location Address
First Line	:	250 S RONALD REAGAN BLVD STE 106
Second Line	:
City	:	LONGWOOD
State	:	FL
Zip	:	32750-5466
Country	:	US
Telephone Number	:	407-342-4220
Fax Number	:	888-808-5278

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

Provider Enumeration Date	:	12/19/2013
Last Update Date	:	03/04/2019

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