MEDICARE: LEYANI FABELO

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-24-361941	FL

General Provider Information

NPI Number	:	1457182941
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEYANI FABELO

Provider Business Mailing Address
First Line	:	659 WINDERMERE DR FL 33972
Second Line	:
City	:	LEHIGH ACRES
State	:	FL
Zip	:	33972-1071
Country	:	US
Telephone Number	:	305-393-9648
Fax Number	:

Provider Business Practice Location Address
First Line	:	5051 MEMORIAL HWY UNIT B
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33634-7355
Country	:	US
Telephone Number	:	813-290-0779
Fax Number	:

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

Provider Enumeration Date	:	08/08/2024
Last Update Date	:	08/08/2024

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Directions to “ LEYANI FABELO ” Practice Location

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