MEDICARE: CATRINA IMANI VISVALINGAM

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

General Provider Information

NPI Number	:	1801765821
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CATRINA IMANI VISVALINGAM

Provider Business Mailing Address
First Line	:	8461 RIVER BRANCH PL
Second Line	:
City	:	SANFORD
State	:	FL
Zip	:	32771-8358
Country	:	US
Telephone Number	:	407-406-2722
Fax Number	:

Provider Business Practice Location Address
First Line	:	4302 W EL PRADO BLVD
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33629-8405
Country	:	US
Telephone Number	:	813-461-5380
Fax Number	:

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

Provider Enumeration Date	:	10/30/2025
Last Update Date	:	10/30/2025

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