MEDICARE: PRINCE AUGUSTIN

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	RBT-25-485748	FL

General Provider Information

NPI Number	:	1992654933
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PRINCE AUGUSTIN

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	:	6909 OLD HIGHWAY 41 S
Second Line	:	SUITE 119
City	:	MOUNT DORA
State	:	FL
Zip	:	32757
Country	:	US
Telephone Number	:	352-358-5001
Fax Number	:	317-520-8200

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

Provider Enumeration Date	:	01/23/2026
Last Update Date	:	01/26/2026

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Directions to “ PRINCE AUGUSTIN ” Practice Location

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