Healthcare Provider Details

I. General information

NPI: 1336940287
Provider Name (Legal Business Name): AMELIS CUELLAR RAMALLO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2025
Last Update Date: 03/24/2025
Certification Date: 03/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8461 LAKE WORTH RD STE 150
LAKE WORTH FL
33467-2474
US

IV. Provider business mailing address

5655 DAPHNE DR
WEST PALM BEACH FL
33415-7156
US

V. Phone/Fax

Practice location:
  • Phone: 561-315-4170
  • Fax:
Mailing address:
  • Phone: 561-386-2487
  • 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: