Provider Demographics
NPI:1235710724
Name:AYBAR, SAYONARA I (MED, ACAS)
Entity Type:Individual
Prefix:MS
First Name:SAYONARA
Middle Name:I
Last Name:AYBAR
Suffix:
Gender:F
Credentials:MED, ACAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:407 HONEYBEE LN
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30115-4265
Mailing Address - Country:US
Mailing Address - Phone:646-399-6368
Mailing Address - Fax:
Practice Address - Street 1:407 HONEYBEE LN
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30115-4265
Practice Address - Country:US
Practice Address - Phone:646-399-6368
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-16
Last Update Date:2021-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLACAS21710596106E00000X, 103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst