Provider Demographics
NPI:1285394536
Name:SOSA, AILYN (RBT)
Entity type:Individual
Prefix:
First Name:AILYN
Middle Name:
Last Name:SOSA
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 1:10330 N DALE MABRY HWY STE 210
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33618-4404
Mailing Address - Country:US
Mailing Address - Phone:813-557-1525
Mailing Address - Fax:
Practice Address - Street 1:10330 N DALE MABRY HWY STE 210
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33618-4404
Practice Address - Country:US
Practice Address - Phone:813-557-1525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-28
Last Update Date:2021-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL21-195717106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician