Healthcare Provider Details

I. General information

NPI: 1467374900
Provider Name (Legal Business Name): MERLY SARITA PATROCINIO GONZALES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 WAYMONT CT STE 122
LAKE MARY FL
32746-3413
US

IV. Provider business mailing address

100 SPRINGHURST CIR
LAKE MARY FL
32746-4207
US

V. Phone/Fax

Practice location:
  • Phone: 302-334-8458
  • Fax:
Mailing address:
  • Phone: 407-687-1203
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: