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NPI Code Detail

MEDICARE: FANTASHI ADDISON

MEDICARE: FANTASHI ADDISON
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 : 1891638714
Entity Type Code : Individual
Provider Name (Legal Business Name) : FANTASHI ADDISON
Provider Business Mailing Address
First Line : 3500 DEPAUW BLVD STE 3070
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46268-6135
Country : US
Telephone Number : 855-324-0885
Fax Number : 317-520-8200
Provider Business Practice Location Address
First Line : 3600 MACLAY BLVD S STE 100
Second Line :
City : TALLAHASSEE
State : FL
Zip : 32312-1276
Country : US
Telephone Number : 850-333-1279
Fax Number : 317-520-8200
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/14/2026
Last Update Date : 04/14/2026

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Directions to “ FANTASHI ADDISON ” Practice Location

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