Healthcare Provider Details

I. General information

NPI: 1194648949
Provider Name (Legal Business Name): DEBORAH RIDORE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12493 BRANTLEY COMMONS CT FL 33907
FORT MYERS FL
33907-5693
US

IV. Provider business mailing address

3805 12TH ST SW
LEHIGH ACRES FL
33976-2812
US

V. Phone/Fax

Practice location:
  • Phone: 754-308-4058
  • Fax:
Mailing address:
  • Phone: 754-308-4058
  • Fax: 754-308-4058

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number1426991
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: