Active NPI
Audreanna Kathleen Tirado
- Behavior Analyst
- Casselberry, FL
National Provider Identifier
1003310731
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Analyst
- License
- 1-21-48705
- Practice address
- 148 Wilshire Blvd
Casselberry, FL 32707 - Phone
- (407) 978-6085
- NPI assigned
- Mar 19, 2018
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Assistant Behavior Analyst | 106E00000X | 0-19-10066 | ||
| Behavior Technician | 106S00000X | RBT-17-44213 | FL | |
| Behavior Analyst | 103K00000X | 1-21-48705 | Primary |
Addresses
Primary practice location
148 Wilshire Blvd
Casselberry, FL 32707
Mailing address
159 Maple Dr
Kissimmee, FL 34759-5580
Phone (407) 491-8567
Other practice location 1
148 Wilshire Blvd
Casselberry, FL 32707
Phone (407) 978-6085
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 021142900 | Medicaid | FL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RBT-17-44213 | FL | MD | Behavior Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1521417600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1668384000000",
"number": "1003310731",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "159 MAPLE DR",
"city": "KISSIMMEE",
"state": "FL",
"postal_code": "347595580",
"telephone_number": "407-491-8567"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "148 WILSHIRE BLVD",
"city": "CASSELBERRY",
"state": "FL",
"postal_code": "32707",
"telephone_number": "407-978-6085"
}
],
"practiceLocations": [
{
"address_1": "148 Wilshire Blvd",
"address_purpose": "LOCATION",
"city": "Casselberry",
"state": "FL",
"postal_code": "32707",
"country_code": "US",
"telephone_number": "407-978-6085",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "TIRADO",
"first_name": "AUDREANNA",
"middle_name": "KATHLEEN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-03-19",
"last_updated": "2022-11-14",
"certification_date": "2022-11-14",
"status": "A"
},
"taxonomies": [
{
"code": "106E00000X",
"taxonomy_group": "",
"desc": "Assistant Behavior Analyst",
"state": null,
"license": "0-19-10066",
"primary": false
},
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": "FL",
"license": "RBT-17-44213",
"primary": false
},
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": null,
"license": "1-21-48705",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "021142900",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Casselberry, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.