Amanda Leigh Evanicki

Primary specialty

Behavior TechnicianTaxonomy code 106S00000X

License

19-90854 Issued in FL

Practice address

4101 NW 22ND St
Cape Coral, FL 33993-3442

Phone

(561) 573-7902

NPI assigned

Aug 23, 2019

Last updated

Aug 23, 2019By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1566518400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1566518400000",
    "number": "1184271249",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4101 NW 22ND ST",
            "city": "CAPE CORAL",
            "state": "FL",
            "postal_code": "339933442"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4101 NW 22ND ST",
            "city": "CAPE CORAL",
            "state": "FL",
            "postal_code": "339933442",
            "telephone_number": "561-573-7902"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EVANICKI",
        "first_name": "AMANDA",
        "middle_name": "LEIGH",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-08-23",
        "last_updated": "2019-08-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": "FL",
            "license": "106S00000X",
            "primary": false
        },
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": "FL",
            "license": "19-90854",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Esthetics Wellness International LLC
• Annet Estrada Bernal
• Elisabeth Estrada
• Priscilla Estrella
• Michael Charles Evanick, PHARMD
• Albert Carleton Evans, O.D.
• Barbara J Evans, ARNP
• Deborah Renee Evans, LCSW
• William P. Evans, MD
• Eveca Behavior Corp

• Behavior Technician in Cape Coral, FL
• Providers in Cape Coral, FL by specialty
• Behavior Technician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 2019; 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.