MEDICARE: CANDIES BISHOP QASP-S

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	1427472679	OTHER	FL	NPI

General Provider Information

NPI Number	:	1427472679
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CANDIES BISHOP QASP-S

Provider Business Mailing Address
First Line	:	225 S SWOOPE AVE STE 211
Second Line	:
City	:	MAITLAND
State	:	FL
Zip	:	32751-5786
Country	:	US
Telephone Number	:	407-928-0444
Fax Number	:

Provider Business Practice Location Address
First Line	:	533 N NOVA RD STE 204
Second Line	:
City	:	ORMOND BEACH
State	:	FL
Zip	:	32174-4422
Country	:	US
Telephone Number	:	386-898-5003
Fax Number	:

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

Provider Enumeration Date	:	02/07/2014
Last Update Date	:	03/17/2018

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