Healthcare Provider Details

I. General information

NPI: 1528672334
Provider Name (Legal Business Name): MICHELLE PALACIOS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2020
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22516 CURLE RD
EUSTIS FL
32736-8933
US

IV. Provider business mailing address

22516 CURLE RD
EUSTIS FL
32736-8933
US

V. Phone/Fax

Practice location:
  • Phone: 305-305-0058
  • Fax:
Mailing address:
  • Phone: 305-305-0058
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number20-122251
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: