MEDICARE: ASTER WALLACE

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	106E00000X	Assistant Behavior Analyst

General Provider Information

NPI Number	:	1770449555
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASTER WALLACE

Provider Business Mailing Address
First Line	:	918 ESSEX RD
Second Line	:
City	:	BRANDON
State	:	FL
Zip	:	33510-2735
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	918 ESSEX RD
Second Line	:
City	:	BRANDON
State	:	FL
Zip	:	33510-2735
Country	:	US
Telephone Number	:	813-326-5835
Fax Number	:

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

Provider Enumeration Date	:	12/24/2025
Last Update Date	:	12/24/2025

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Directions to “ ASTER WALLACE ” Practice Location

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