Healthcare Provider Details

I. General information

NPI: 1336978758
Provider Name (Legal Business Name): ROSANA VALESKA ARAUJO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2024
Last Update Date: 08/01/2024
Certification Date: 08/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4431 SOLAMAR AVE APT 106
KISSIMMEE FL
34746-6810
US

IV. Provider business mailing address

4431 SOLAMAR AVE APT 106
KISSIMMEE FL
34746-6810
US

V. Phone/Fax

Practice location:
  • Phone: 774-329-3537
  • Fax:
Mailing address:
  • Phone: 774-329-3537
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TR0400X
TaxonomyRehabilitation Psychologist
License NumberA622-738-88-873-0
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: