MEDICARE: SFABA UT LLC

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	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1952118101
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SFABA UT LLC

Provider Business Mailing Address
First Line	:	333 W 41ST ST STE 324
Second Line	:
City	:	MIAMI BEACH
State	:	FL
Zip	:	33140-3642
Country	:	US
Telephone Number	:	786-673-9355
Fax Number	:	954-342-6481

Provider Business Practice Location Address
First Line	:	50 W BROADWAY UNIT 313
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84101-2020
Country	:	US
Telephone Number	:	786-673-9355
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	YOAD ELMALEH
Credential	:
Telephone Number	:	718-722-0269

Provider Enumeration Date	:	12/11/2024
Last Update Date	:	12/11/2024

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Directions to “SFABA UT LLC ” Practice Location

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