Organization
AUTISM AWARENESS SHOP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TYLER RUSSO (GENERAL MANAGER)
(631) 413-1616
Entity
Organization
Contact information
Practice address
2908 W HILLSBOROUGH AVE, TAMPA, FL 33614-6055
(813) 879-6770
Mailing address
2908 W HILLSBOROUGH AVE, TAMPA, FL 33614-6055
(813) 879-6770
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1780737999
—
NY
Enumeration date
12/24/2021
Last updated
07/06/2022
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