Individual provider Active NPI

Sharon Helena Willis, BCABA

  • Assistant Behavior Analyst
  • Cocoa, FL
National Provider Identifier
1053620559
Registry record updated Nov 4, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Assistant Behavior AnalystTaxonomy code 106E00000X
Practice address
7075 N Highway 1
Cocoa, FL 32927-5216
Phone
(321) 888-3020
NPI assigned
Sep 30, 2010
Last updated
Nov 4, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 4, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Assistant Behavior Analyst 106E00000X FL Primary

Addresses

Primary practice location

7075 N Highway 1
Cocoa, FL 32927-5216

Mailing address

475 S John Rodes Blvd
Melbourne, FL 32904-1093
Phone (321) 241-1170

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

Practice roles

OrganizationSpecialtyStatusNew patients
The Sonder Academy Past Accepting new patients

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1285804800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1604448000000",
    "number": "1053620559",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "475 S JOHN RODES BLVD",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329041093",
            "telephone_number": "321-241-1170",
            "fax_number": "321-241-1171"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7075 N HIGHWAY 1",
            "city": "COCOA",
            "state": "FL",
            "postal_code": "329275216",
            "telephone_number": "321-888-3020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLIS",
        "first_name": "SHARON",
        "middle_name": "HELENA",
        "name_prefix": "Ms.",
        "credential": "BCABA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-09-30",
        "last_updated": "2020-11-04",
        "certification_date": "2020-11-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106E00000X",
            "taxonomy_group": "",
            "desc": "Assistant Behavior Analyst",
            "state": "FL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cocoa, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.