Provider Demographics
NPI:1750080537
Name:SIDD, HAYDEN (BA, BCABA)
Entity type:Individual
Prefix:
First Name:HAYDEN
Middle Name:
Last Name:SIDD
Suffix:
Gender:M
Credentials:BA, BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2710 STATEN AVE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32804-4211
Mailing Address - Country:US
Mailing Address - Phone:305-332-1772
Mailing Address - Fax:877-690-2003
Practice Address - Street 1:2710 STATEN AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-4211
Practice Address - Country:US
Practice Address - Phone:305-332-1772
Practice Address - Fax:877-690-2003
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-01
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0-21-11931106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst