Provider Demographics
NPI:1245685627
Name:SOUTH FLORIDA AUTISM CENTER
Entity type:Organization
Organization Name:SOUTH FLORIDA AUTISM CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TAMARA
Authorized Official - Middle Name:LATOYA
Authorized Official - Last Name:MOODIE
Authorized Official - Suffix:
Authorized Official - Credentials:PH D
Authorized Official - Phone:305-823-2700
Mailing Address - Street 1:3751 W 108TH ST
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33018-2218
Mailing Address - Country:US
Mailing Address - Phone:305-823-2700
Mailing Address - Fax:305-823-2705
Practice Address - Street 1:18305 NW 75TH PL
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015-2957
Practice Address - Country:US
Practice Address - Phone:305-823-2700
Practice Address - Fax:305-823-2705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-04
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL597079Medicaid