MEDICARE: KELLY NEGRON

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
2	222Q00000X	Developmental Therapist		FL
3	103K00000X	Behavior Analyst	15098	TX

General Provider Information

NPI Number	:	1275918740
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY NEGRON

Provider Business Mailing Address
First Line	:	3313 DELANA WAY
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33905-5742
Country	:	US
Telephone Number	:	650-213-2283
Fax Number	:

Provider Business Practice Location Address
First Line	:	11575 CITY HALL PROMENADE UNIT 151
Second Line	:
City	:	MIRAMAR
State	:	FL
Zip	:	33025-7585
Country	:	US
Telephone Number	:	650-213-2283
Fax Number	:

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

Provider Enumeration Date	:	07/27/2015
Last Update Date	:	04/18/2025

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Directions to “ KELLY NEGRON ” Practice Location

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