Healthcare Provider Details

I. General information

NPI: 1063316545
Provider Name (Legal Business Name): GISELL ALLEGUE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/07/2026
Last Update Date: 10/07/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 DIPLOMAT PKWY E
CAPE CORAL FL
33909-5244
US

IV. Provider business mailing address

130 DIPLOMAT PKWY E
CAPE CORAL FL
33909-5244
US

V. Phone/Fax

Practice location:
  • Phone: 239-203-6085
  • Fax:
Mailing address:
  • Phone: 239-203-6085
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number262854757
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: