Provider Demographics
NPI:1508415050
Name:CAMPBELL, SANDI (RBT)
Entity Type:Individual
Prefix:MS
First Name:SANDI
Middle Name:
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6941 SW 10TH ST
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33023-1634
Mailing Address - Country:US
Mailing Address - Phone:305-720-5908
Mailing Address - Fax:
Practice Address - Street 1:13195 SW 134TH ST STE 201
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-4585
Practice Address - Country:US
Practice Address - Phone:786-206-6500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-07
Last Update Date:2022-06-02
Deactivation Date:2019-09-08
Deactivation Code:
Reactivation Date:2019-09-18
Provider Licenses
StateLicense IDTaxonomies
103K00000X, 106E00000X, 106S00000X
FLRBT-19-97897103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician