Provider Demographics
NPI:1982327086
Name:SEARS, KENIYAH
Entity Type:Individual
Prefix:
First Name:KENIYAH
Middle Name:
Last Name:SEARS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1091 POST LAKE PL APT 305
Mailing Address - Street 2:
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32703-2909
Mailing Address - Country:US
Mailing Address - Phone:321-987-9972
Mailing Address - Fax:
Practice Address - Street 1:3200 S HIAWASSEE RD SUITE 203
Practice Address - Street 2:ROOM 1197
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32835
Practice Address - Country:US
Practice Address - Phone:407-745-1930
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-22
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-22-234707106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician