Active NPI
Desean Wallace
- Behavior Technician
- Greenacres, FL
National Provider Identifier
1689483182
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- License
- RBT-24-401566
- Practice address
- 6383 10TH Ave N Ste E
Greenacres, FL 33463-1689 - Phone
- (561) 429-5794
- NPI assigned
- Dec 31, 2024
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | RBT-24-401566 | FL | Primary |
Addresses
Primary practice location
6383 10TH Ave N Ste E
Greenacres, FL 33463-1689
Mailing address
5203 Matanzas Ave
Fort Pierce, FL 34946-1002
Phone (706) 832-5640
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 |
|---|---|---|---|
| RBT-24-401566 | FL | MD | Behavior Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1735603200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1771286400000",
"number": "1689483182",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5203 MATANZAS AVE",
"city": "FORT PIERCE",
"state": "FL",
"postal_code": "349461002",
"telephone_number": "706-832-5640"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6383 10TH AVE N STE E",
"city": "GREENACRES",
"state": "FL",
"postal_code": "334631689",
"telephone_number": "561-429-5794"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALLACE",
"first_name": "DESEAN",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2024-12-31",
"last_updated": "2026-02-17",
"certification_date": "2026-02-17",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Behavior Technician",
"state": "FL",
"license": "RBT-24-401566",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Greenacres, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 17, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.