Provider Demographics
NPI:1720626567
Name:FURMAN-VANDYKE, SARA LYNN (RBT)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:LYNN
Last Name:FURMAN-VANDYKE
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3344 NE SANDRA DR
Mailing Address - Street 2:
Mailing Address - City:JENSEN BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:34957-3972
Mailing Address - Country:US
Mailing Address - Phone:407-947-4675
Mailing Address - Fax:772-209-6900
Practice Address - Street 1:821 SE OCEAN BLVD
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-2456
Practice Address - Country:US
Practice Address - Phone:407-947-4675
Practice Address - Fax:772-209-6900
Is Sole Proprietor?:No
Enumeration Date:2019-12-11
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL16-15797106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician