Healthcare Provider Details

I. General information

NPI: 1720890817
Provider Name (Legal Business Name): KEYSHLA M PEREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2025
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

502 N SPRING GARDEN AVE
DELAND FL
32720-3193
US

IV. Provider business mailing address

41740 SHADOW LN
DELAND FL
32720-6144
US

V. Phone/Fax

Practice location:
  • Phone: 407-625-5836
  • Fax:
Mailing address:
  • Phone: 407-818-9397
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-25-407680
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: