Healthcare Provider Details

I. General information

NPI: 1710713557
Provider Name (Legal Business Name): BRIANNA PATRICIA SEELALL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2024
Last Update Date: 09/09/2024
Certification Date: 09/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 PARK PLACE BLVD STE C1
KISSIMMEE FL
34741-2358
US

IV. Provider business mailing address

15840 STATE ROAD 50 LOT 84
CLERMONT FL
34711-8718
US

V. Phone/Fax

Practice location:
  • Phone: 407-385-0728
  • Fax:
Mailing address:
  • Phone: 407-529-8244
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-24-374891
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: