MEDICARE: AKESHA GRONDIN

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
2	103K00000X	Behavior Analyst	1-23-65833	FL

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	:	1497389753
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AKESHA GRONDIN

Provider Business Mailing Address
First Line	:	8701 MAITLAND SUMMIT BLVD
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32810-5915
Country	:	US
Telephone Number	:	407-574-4629
Fax Number	:

Provider Business Practice Location Address
First Line	:	2096 HALIFAX DR
Second Line	:
City	:	PORT ORANGE
State	:	FL
Zip	:	32128-3619
Country	:	US
Telephone Number	:	617-595-6424
Fax Number	:

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

Provider Enumeration Date	:	02/26/2020
Last Update Date	:	06/08/2023

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Directions to “ AKESHA GRONDIN ” Practice Location

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