Provider Demographics
NPI:1558854281
Name:DIAMANDIS, THIANNA MARIE (BCABA)
Entity Type:Individual
Prefix:
First Name:THIANNA
Middle Name:MARIE
Last Name:DIAMANDIS
Suffix:
Gender:F
Credentials:BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 GRAND BLVD
Mailing Address - Street 2:
Mailing Address - City:TARPON SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34689-3219
Mailing Address - Country:US
Mailing Address - Phone:727-485-7655
Mailing Address - Fax:
Practice Address - Street 1:10330 N DALE MABRY HWY STE 210
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33618-4404
Practice Address - Country:US
Practice Address - Phone:813-557-1525
Practice Address - Fax:813-435-2015
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-07
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL020159300Medicaid