MEDICARE: ABA DYNAMIC LEARNING 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	:	1972455756
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ABA DYNAMIC LEARNING LLC

Provider Business Mailing Address
First Line	:	3020 W NEW HAVEN AVE STE 120
Second Line	:
City	:	WEST MELBOURNE
State	:	FL
Zip	:	32904-3565
Country	:	US
Telephone Number	:	561-497-5612
Fax Number	:

Provider Business Practice Location Address
First Line	:	3020 W NEW HAVEN AVE STE 120
Second Line	:
City	:	WEST MELBOURNE
State	:	FL
Zip	:	32904-3565
Country	:	US
Telephone Number	:	561-497-5612
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	SAMUEL HERNANDEZ CARMENATE
Credential	:	BCBA
Telephone Number	:	561-497-5612

Provider Enumeration Date	:	02/12/2026
Last Update Date	:	03/05/2026

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