Provider Demographics
NPI:1114436029
Name:SIMBULAN, JAYMEE ANN SAMBO (BCBA)
Entity Type:Individual
Prefix:
First Name:JAYMEE ANN
Middle Name:SAMBO
Last Name:SIMBULAN
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1056 NIN ST
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32835-5135
Mailing Address - Country:US
Mailing Address - Phone:407-600-7463
Mailing Address - Fax:
Practice Address - Street 1:3200 S HIAWASSEE RD STE 203
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32835-6317
Practice Address - Country:US
Practice Address - Phone:407-600-7463
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-22
Last Update Date:2018-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106E00000X
103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst