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NPI Code Detail

MEDICARE: KENITH SANDIFER

MEDICARE: KENITH SANDIFER
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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1558712984
Entity Type Code : Individual
Provider Name (Legal Business Name) : KENITH SANDIFER
Provider Business Mailing Address
First Line : 13201 SUGARBLUFF RD
Second Line :
City : CLERMONT
State : FL
Zip : 34715-6819
Country : US
Telephone Number : 352-223-1999
Fax Number :
Provider Business Practice Location Address
First Line : 350 ACCEPTANCE WAY
Second Line :
City : CLERMONT
State : FL
Zip : 34711-2788
Country : US
Telephone Number : 352-223-1999
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/27/2016
Last Update Date : 09/09/2024

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Directions to “ KENITH SANDIFER ” Practice Location

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