Provider Demographics
NPI:1982113999
Name:SULANJAKU, BELINA (BCBA, RBT)
Entity Type:Individual
Prefix:
First Name:BELINA
Middle Name:
Last Name:SULANJAKU
Suffix:
Gender:F
Credentials:BCBA, RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4836 GRASSENDALE TER
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32771-0043
Mailing Address - Country:US
Mailing Address - Phone:407-860-3675
Mailing Address - Fax:
Practice Address - Street 1:4836 GRASSENDALE TER
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32771-0043
Practice Address - Country:US
Practice Address - Phone:407-860-3675
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-21
Last Update Date:2020-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-18-62813106S00000X
FL1-20-41911103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL019564700Medicaid