Healthcare Provider Details

I. General information

NPI: 1598349482
Provider Name (Legal Business Name): ADRIA CARBALLO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2021
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8140 COLLEGE PKWY STE 107
FORT MYERS FL
33919-4111
US

IV. Provider business mailing address

10250 SW 56TH ST STE A202
MIAMI FL
33165-7095
US

V. Phone/Fax

Practice location:
  • Phone: 239-360-7963
  • Fax:
Mailing address:
  • Phone: 888-527-8037
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-25-81441
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: