Provider Demographics
NPI:1215522420
Name:CARR SANCHO, KRYSTAL D (MED, BCBA)
Entity type:Individual
Prefix:
First Name:KRYSTAL
Middle Name:D
Last Name:CARR SANCHO
Suffix:
Gender:F
Credentials:MED, BCBA
Other - Prefix:
Other - First Name:KRYSTAL
Other - Middle Name:
Other - Last Name:CARR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4640 NE 16TH PL
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34470-8018
Mailing Address - Country:US
Mailing Address - Phone:352-207-5388
Mailing Address - Fax:
Practice Address - Street 1:1601 NE 25TH AVE STE 405
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34470-8826
Practice Address - Country:US
Practice Address - Phone:352-456-7248
Practice Address - Fax:352-481-1811
Is Sole Proprietor?:No
Enumeration Date:2021-03-09
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-22-57591103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL109802500Medicaid