Provider Demographics
NPI:1922361682
Name:TRIGLIA, SANDRA (MSED, BCBA)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:
Last Name:TRIGLIA
Suffix:
Gender:F
Credentials:MSED, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12356 MOSS LAKE LOOP
Mailing Address - Street 2:
Mailing Address - City:TRINITY
Mailing Address - State:FL
Mailing Address - Zip Code:34655-2328
Mailing Address - Country:US
Mailing Address - Phone:727-597-2335
Mailing Address - Fax:
Practice Address - Street 1:12356 MOSS LAKE LOOP
Practice Address - Street 2:
Practice Address - City:TRINITY
Practice Address - State:FL
Practice Address - Zip Code:34655-2328
Practice Address - Country:US
Practice Address - Phone:727-597-2335
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-19
Last Update Date:2017-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
NY1-07-3212103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst