Healthcare Provider Details

I. General information

NPI: 1508721853
Provider Name (Legal Business Name): BROOKE ANNE RAO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/18/2025
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1975 S JOHN YOUNG PKWY STE 203
KISSIMMEE FL
34741-0605
US

IV. Provider business mailing address

1100 GARY DR
SAINT CLOUD FL
34772-8946
US

V. Phone/Fax

Practice location:
  • Phone: 407-201-6255
  • Fax: 407-201-7195
Mailing address:
  • Phone: 407-201-6255
  • Fax: 407-201-7195

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-25-462645
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: