Active NPI
Breanna M Sandefur, RBT
- Behavior Analyst
- Tigard, OR
National Provider Identifier
1427573146
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Analyst
- License
- 10212643
- Practice address
- 15290 SW Royalty Pkwy
Tigard, OR 97224 - Phone
- (971) 256-4050
- NPI assigned
- Aug 3, 2017
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | RBT-19-96158 | OR | |
| Behavior Technician | 106S00000X | |||
| Behavior Analyst | 103K00000X | 10212643 | OR | Primary |
Addresses
Primary practice location
15290 SW Royalty Pkwy
Tigard, OR 97224
Mailing address
21600 Oxnard St Ste 1800
Woodland Hills, CA 91367-7807
Phone (818) 345-2345
Other practice location 1
Uw Autism Ctr 1701 NE Columbia Rd
Seattle, WA 98195-0001
Phone (206) 618-8642
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
| License | State | Type | Specialty |
|---|---|---|---|
| 10212643 | OR | MD | Behavioral Analyst |
| RBT-19-96158 | OR | MD | Behavior Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1501718400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1620086400000",
"number": "1427573146",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "21600 OXNARD ST STE 1800",
"city": "WOODLAND HILLS",
"state": "CA",
"postal_code": "913677807",
"telephone_number": "818-345-2345"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "15290 SW ROYALTY PKWY",
"city": "TIGARD",
"state": "OR",
"postal_code": "97224",
"telephone_number": "971-256-4050"
}
],
"practiceLocations": [
{
"address_1": "Uw Autism Ctr 1701 NE Columbia Rd",
"address_purpose": "LOCATION",
"city": "Seattle",
"state": "WA",
"postal_code": "981950001",
"country_code": "US",
"telephone_number": "206-618-8642",
"fax_number": "206-598-7815",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "SANDEFUR",
"first_name": "BREANNA",
"middle_name": "M",
"credential": "RBT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-08-03",
"last_updated": "2021-05-04",
"certification_date": "2021-05-04",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": "OR",
"license": "RBT-19-96158",
"primary": false
},
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": null,
"license": null,
"primary": false
},
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": "OR",
"license": "10212643",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tigard, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 4, 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.