Healthcare Provider Details

I. General information

NPI: 1730603309
Provider Name (Legal Business Name): STEPHANIE ROSA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2017
Last Update Date: 11/11/2025
Certification Date: 11/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4727 W IRLO BRONSON MEMORIAL HWY
KISSIMMEE FL
34746-5326
US

IV. Provider business mailing address

2815 MIDDLETON CIR
KISSIMMEE FL
34743-5623
US

V. Phone/Fax

Practice location:
  • Phone: 407-978-6085
  • Fax:
Mailing address:
  • Phone: 407-624-7168
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number0-20-11483
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-25-85604
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: