Healthcare Provider Details

I. General information

NPI: 1962290239
Provider Name (Legal Business Name): CHERYL ANN VACCA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2025
Last Update Date: 05/09/2025
Certification Date: 05/09/2025
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

3020 W BAY CIR APT 509
KISSIMMEE FL
34747-2309
US

V. Phone/Fax

Practice location:
  • Phone: 321-972-4039
  • Fax:
Mailing address:
  • Phone: 978-631-7881
  • 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: