Fundamental ABA Therapy,LLC

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

Legal business name

FUNDAMENTAL ABA THERAPY,LLC

Practice address

8053 W Oakland Park Blvd Ste 950
Sunrise, FL 33351-1162

Phone

(754) 422-2165

NPI assigned

Dec 29, 2020

Organization subpart

No

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

Authorized official

Name

Nicole Phillips, BCBANPI 1508364019

Title

Manager

Phone

(754) 422-2165

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Nicole Phillips, BCBA

  • Behavior Analyst
  • Sunrise, FL
  • NPI 1508364019
  NPD Authorized official

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

{
    "created_epoch": "1609200000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1669593600000",
    "number": "1609463298",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5529 NW 90TH AVE",
            "city": "SUNRISE",
            "state": "FL",
            "postal_code": "333517776",
            "telephone_number": "754-422-2165"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8053 W OAKLAND PARK BLVD STE 950",
            "city": "SUNRISE",
            "state": "FL",
            "postal_code": "333511162",
            "telephone_number": "754-422-2165"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FUNDAMENTAL ABA THERAPY,LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-12-29",
        "last_updated": "2022-11-28",
        "certification_date": "2021-02-20",
        "status": "A",
        "authorized_official_last_name": "PHILLIPS",
        "authorized_official_first_name": "NICOLE",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "754-422-2165",
        "authorized_official_credential": "BCBA"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Behavior Analyst",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gretta Marie Fuentes
• Jayme Tahilah Fuentes
• Peter F Fuerst, DDS
• Neema A Fuller, MD
• Functional Health Management, LLC
• Tatiana Christine Fyodorov
• G and G Chiropractic L.L.C
• Maria T. Gabo, RN MSN PHN BSN CCM
• Jenifer Espiritu Gabrang, RPT
• Jourdan Gabriel, LCSW

• Behavior Analyst in Sunrise, FL
• Providers in Sunrise, FL by specialty
• Behavior Analyst in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 28, 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.