Amy Enderli, BCBA

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

License

1-18-33052 Issued in FL

Practice address

4225 Portsmouth Blvd Ste B
Chesapeake, VA 23321-2154

Phone

(309) 212-5021

Fax

(757) 282-7585

NPI assigned

Dec 1, 2017

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

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1512086400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1717027200000",
    "number": "1336653153",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1618 HAZEL AVE",
            "city": "CHESAPEAKE",
            "state": "VA",
            "postal_code": "233253840",
            "telephone_number": "309-212-5021"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4225 PORTSMOUTH BLVD STE B",
            "city": "CHESAPEAKE",
            "state": "VA",
            "postal_code": "233212154",
            "telephone_number": "309-212-5021",
            "fax_number": "757-282-7585"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ENDERLI",
        "first_name": "AMY",
        "credential": "BCBA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-12-01",
        "last_updated": "2024-05-30",
        "certification_date": "2022-03-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "FL",
            "license": "1-18-33052",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "023139300",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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

Verify at the official NPI Registry.