Healthcare Provider Details

I. General information

NPI: 1255246203
Provider Name (Legal Business Name): JEAN SEBASTIAN SOLIVAN PACHECO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2026
Last Update Date: 08/15/2026
Certification Date: 08/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 WAYMONT CT STE 101
LAKE MARY FL
32746-3566
US

IV. Provider business mailing address

119 BELGIAN WAY
SANFORD FL
32773-6857
US

V. Phone/Fax

Practice location:
  • Phone: 954-850-1920
  • Fax:
Mailing address:
  • Phone: 689-238-9458
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: