Provider Demographics
NPI:1528862463
Name:SANFORD-BASS, LAQUAISHA
Entity type:Individual
Prefix:
First Name:LAQUAISHA
Middle Name:
Last Name:SANFORD-BASS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LAQUAISHA
Other - Middle Name:
Other - Last Name:ENGLISH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:14606 UNBRIDLED DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32826-6509
Mailing Address - Country:US
Mailing Address - Phone:321-588-9327
Mailing Address - Fax:
Practice Address - Street 1:14606 UNBRIDLED DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32826-6509
Practice Address - Country:US
Practice Address - Phone:321-588-9327
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-01
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician