Healthcare Provider Details

I. General information

NPI: 1659051134
Provider Name (Legal Business Name): CYNTHIA A GAVILANES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2023
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8140 COLLEGE PKWY STE E
FORT MYERS FL
33919-5188
US

IV. Provider business mailing address

202 NE 9TH PL
CAPE CORAL FL
33909-2630
US

V. Phone/Fax

Practice location:
  • Phone: 239-360-7963
  • Fax: 239-360-7967
Mailing address:
  • Phone: 305-491-7233
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: