Healthcare Provider Details

I. General information

NPI: 1629932017
Provider Name (Legal Business Name): YANELIS DEL ROCIO ZAYAS BACALLAO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2025
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

912 SILVERLAKE BLVD
LAKE ALFRED FL
33850-7112
US

IV. Provider business mailing address

912 SILVERLAKE BLVD
LAKE ALFRED FL
33850-7112
US

V. Phone/Fax

Practice location:
  • Phone: 717-255-9829
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberZ246-279-91-800-0
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: