Healthcare Provider Details

I. General information

NPI: 1851272280
Provider Name (Legal Business Name): MICHAEL PANEBIANCO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2025
Last Update Date: 09/11/2025
Certification Date: 09/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1342 SE 46TH LN
CAPE CORAL FL
33904-8617
US

IV. Provider business mailing address

1718 NW 7TH AVE
CAPE CORAL FL
33993-4025
US

V. Phone/Fax

Practice location:
  • Phone: 239-961-3032
  • Fax: 239-310-2045
Mailing address:
  • Phone: 239-850-9507
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-25-469966
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: