Individual provider Active NPI

Priscilla Marie Quevedo, BCBA

  • Behavior Analyst
  • Davie, FL
National Provider Identifier
1063807642
Registry record updated Jul 12, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Behavior AnalystTaxonomy code 103K00000X
License
1-21-50922 Issued in FL
Practice address
5400 S University Dr Ste 50
Davie, FL 33328-5312
Phone
(888) 754-0398
NPI assigned
Apr 1, 2015
Last updated
Jul 12, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 12, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Behavior Technician 106S00000X RBT-18-73092 FL
Behavior Analyst 103K00000X 1-21-50922 FL Primary

Addresses

Primary practice location

5400 S University Dr Ste 50
Davie, FL 33328-5312

Mailing address

5400 S University Dr Ste 502
Davie, FL 33328-5313
Phone (888) 754-0398

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

LicenseStateTypeSpecialty
RBT-18-73092FLMDBehavior Technician

Practice roles

OrganizationSpecialtyStatusNew patients
Vocational Development Group, LLC Behavior Analyst CurrentSince Jul 20, 2021 Accepting new patients
Foundations Therapy, Inc. PastSince Feb 6, 2022 Accepting new patients
Foundations Therapy, Inc. Past Accepting new patients

Locations

5400 S University Dr
Ste 502
Davie, FL 33328
Phone (888) 875-4039

6416 NW 5th Way
Lauderdale Lakes, FL 33309
Phone (407) 489-2906

Organizations & group practices 3

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": "1427846400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1626048000000",
    "number": "1063807642",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5400 S UNIVERSITY DR STE 502",
            "city": "DAVIE",
            "state": "FL",
            "postal_code": "333285313",
            "telephone_number": "888-754-0398",
            "fax_number": "954-248-3521"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5400 S UNIVERSITY DR STE 50",
            "city": "DAVIE",
            "state": "FL",
            "postal_code": "333285312",
            "telephone_number": "888-754-0398"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "QUEVEDO",
        "first_name": "PRISCILLA",
        "middle_name": "MARIE",
        "name_prefix": "Ms.",
        "credential": "BCBA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-04-01",
        "last_updated": "2021-07-12",
        "certification_date": "2021-07-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": "FL",
            "license": "RBT-18-73092",
            "primary": false
        },
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "FL",
            "license": "1-21-50922",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Davie, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2021; 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.