Healthcare Provider Details

I. General information

NPI: 1851797658
Provider Name (Legal Business Name): DR. CECILIA RUSNAK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2014
Last Update Date: 02/06/2026
Certification Date: 02/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1107 PERSON ST
KISSIMMEE FL
34741-4146
US

IV. Provider business mailing address

1107 PERSON ST
KISSIMMEE FL
34741-4146
US

V. Phone/Fax

Practice location:
  • Phone: 407-624-5258
  • Fax: 407-289-4047
Mailing address:
  • Phone: 407-624-5258
  • Fax: 407-289-4047

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAP3582
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code246Z00000X
TaxonomyOther Specialist/Technologist
License Number48-44-2692456
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: