MEDICARE: ALEXIS RENEE KISSANE RBT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician	RBT-20-148899
2	106E00000X	Assistant Behavior Analyst	0-25-16255	FL

General Provider Information

NPI Number	:	1275315335
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXIS RENEE KISSANE RBT

Provider Business Mailing Address
First Line	:	331 HILLSIDE PARK ST APT 6313
Second Line	:
City	:	MINNEOLA
State	:	FL
Zip	:	34715-6168
Country	:	US
Telephone Number	:	260-431-1525
Fax Number	:

Provider Business Practice Location Address
First Line	:	5739 BYRON ANTHONY PL STE 1001
Second Line	:
City	:	SANFORD
State	:	FL
Zip	:	32771-8638
Country	:	US
Telephone Number	:	321-483-7880
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/13/2023
Last Update Date	:	08/13/2025

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Directions to “ ALEXIS RENEE KISSANE RBT” Practice Location

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