Provider Demographics
NPI:1487222949
Name:SUNSHINE ABA THERAPY SERVICES LLC
Entity type:Organization
Organization Name:SUNSHINE ABA THERAPY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:WAGNER
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:407-670-9047
Mailing Address - Street 1:3209 CYPRESS GROVE DR
Mailing Address - Street 2:
Mailing Address - City:EUSTIS
Mailing Address - State:FL
Mailing Address - Zip Code:32736-2503
Mailing Address - Country:US
Mailing Address - Phone:407-670-9047
Mailing Address - Fax:
Practice Address - Street 1:1803 PARK CENTER DR STE 212
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32835-6216
Practice Address - Country:US
Practice Address - Phone:407-907-2077
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-11
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty