Provider Demographics
NPI:1609373687
Name:KAMAL, ABEDA SHADIANA (BCBA)
Entity Type:Individual
Prefix:
First Name:ABEDA
Middle Name:SHADIANA
Last Name:KAMAL
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 1:535 SEASIDE COVE ST
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-5939
Mailing Address - Country:US
Mailing Address - Phone:407-451-2455
Mailing Address - Fax:
Practice Address - Street 1:535 SEASIDE COVE ST
Practice Address - Street 2:
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-5939
Practice Address - Country:US
Practice Address - Phone:407-451-2455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-06
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL103K00000X
106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL024951700Medicaid