Active NPI
Grace Correa
- Behavior Technician
- Sunrise, FL
National Provider Identifier
1043032030
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- License
- 24372126
- Practice address
- 4117 N Pine Island Rd
Sunrise, FL 33351-6005 - Phone
- (954) 605-0378
- Fax
- (954) 530-4292
- NPI assigned
- Oct 30, 2024
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | 24372126 | FL | Primary |
Addresses
Primary practice location
4117 N Pine Island Rd
Sunrise, FL 33351-6005
Mailing address
4117 N Pine Island Rd
Sunrise, FL 33351-6005
Phone (954) 652-8613
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 |
|---|---|---|---|
| 24372126 | FL | MD | Behavior Technician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Vital Skills Center LLC | Single Specialty | Current | Accepting new patients |
Locations
4117 N Pine Island Rd
Sunrise, FL 33351
Phone (954) 605-0378
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1730246400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1730246400000",
"number": "1043032030",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4117 N PINE ISLAND RD",
"city": "SUNRISE",
"state": "FL",
"postal_code": "333516005",
"telephone_number": "954-652-8613",
"fax_number": "954-530-4292"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4117 N PINE ISLAND RD",
"city": "SUNRISE",
"state": "FL",
"postal_code": "333516005",
"telephone_number": "954-605-0378",
"fax_number": "954-530-4292"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CORREA",
"first_name": "GRACE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2024-10-30",
"last_updated": "2024-10-30",
"certification_date": "2024-10-30",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Behavior Technician",
"state": "FL",
"license": "24372126",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Sunrise, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.