Provider Demographics
NPI:1114262888
Name:RUDY, NIKKI (MS BCBA)
Entity Type:Individual
Prefix:
First Name:NIKKI
Middle Name:
Last Name:RUDY
Suffix:
Gender:F
Credentials:MS BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 N ORANGE AVE STE 800
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32801-2381
Mailing Address - Country:US
Mailing Address - Phone:407-556-9465
Mailing Address - Fax:407-839-6660
Practice Address - Street 1:111 N ORANGE AVE STE 800
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32801-2381
Practice Address - Country:US
Practice Address - Phone:407-556-9465
Practice Address - Fax:407-839-6660
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-06
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-12-12313103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst