Provider Demographics
NPI:1295156032
Name:BEHAVIOR ANALYTIC SOLUTION
Entity type:Organization
Organization Name:BEHAVIOR ANALYTIC SOLUTION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHAVETA
Authorized Official - Middle Name:
Authorized Official - Last Name:SURI
Authorized Official - Suffix:
Authorized Official - Credentials:BCB
Authorized Official - Phone:407-731-0940
Mailing Address - Street 1:3340 LAKE JEAN DRIVE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32817
Mailing Address - Country:US
Mailing Address - Phone:407-731-0940
Mailing Address - Fax:
Practice Address - Street 1:3340 LAKE JEAN DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32817-2326
Practice Address - Country:US
Practice Address - Phone:407-731-0940
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-20
Last Update Date:2013-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health