Provider Demographics
NPI:1689552473
Name:SARDINAS LEON, THAIS B
Entity type:Individual
Prefix:
First Name:THAIS
Middle Name:B
Last Name:SARDINAS LEON
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 1:489 NE 4TH ST
Mailing Address - Street 2:
Mailing Address - City:FLORIDA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33034-3272
Mailing Address - Country:US
Mailing Address - Phone:281-662-9356
Mailing Address - Fax:
Practice Address - Street 1:489 NE 4TH ST
Practice Address - Street 2:
Practice Address - City:FLORIDA CITY
Practice Address - State:FL
Practice Address - Zip Code:33034-3272
Practice Address - Country:US
Practice Address - Phone:281-662-9356
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-21
Last Update Date:2025-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-25-413801106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician