Autism Awareness Shop

Primary specialty

Developmentally Disabled Services Day Training AgencyTaxonomy code 251C00000X

Legal business name

AUTISM AWARENESS SHOP

Practice address

2908 W Hillsborough Ave
Tampa, FL 33614-6055

Phone

(813) 879-6770

NPI assigned

Dec 24, 2021

Last updated

Jul 6, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Tyler Russo

Title

General Manager

Phone

(631) 413-1616

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

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

{
    "created_epoch": "1640304000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1657065600000",
    "number": "1316607849",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2908 W HILLSBOROUGH AVE",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336146055",
            "telephone_number": "813-879-6770"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2908 W HILLSBOROUGH AVE",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336146055",
            "telephone_number": "813-879-6770"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AUTISM AWARENESS SHOP",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-12-24",
        "last_updated": "2022-07-06",
        "certification_date": "2022-07-06",
        "status": "A",
        "authorized_official_last_name": "RUSSO",
        "authorized_official_first_name": "TYLER",
        "authorized_official_title_or_position": "GENERAL MANAGER",
        "authorized_official_telephone_number": "631-413-1616",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251C00000X",
            "taxonomy_group": "",
            "desc": "Day Training, Developmentally Disabled Services",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1780737999",
            "state": "NY"
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "info@autismawarenessshop.org",
            "affiliation": "N",
            "address_1": "2908 W Hillsborough Ave",
            "city": "Tampa",
            "state": "FL",
            "country_code": "US",
            "postal_code": "336146055",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 6, 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.

Verify at the official NPI Registry.