MEDICARE: LAUREN-NOEL SISON FISHER

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

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	:	1821753351
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAUREN-NOEL SISON FISHER

Provider Business Mailing Address
First Line	:	300 INTERNATIONAL PKWY STE 200
Second Line	:
City	:	LAKE MARY
State	:	FL
Zip	:	32746-5028
Country	:	US
Telephone Number	:	866-610-0580
Fax Number	:

Provider Business Practice Location Address
First Line	:	1535 W NASA BLVD UNIT C-1
Second Line	:
City	:	MELBOURNE
State	:	FL
Zip	:	32901-2614
Country	:	US
Telephone Number	:	321-426-7759
Fax Number	:

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

Provider Enumeration Date	:	10/31/2021
Last Update Date	:	10/31/2021

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Directions to “ LAUREN-NOEL SISON FISHER ” Practice Location

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