Healthcare Provider Details

I. General information

NPI: 1831914936
Provider Name (Legal Business Name): KEILAH MELISSA TUFINO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2024
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

454 W PIPKIN RD
LAKELAND FL
33813-2545
US

IV. Provider business mailing address

454 W PIPKIN RD
LAKELAND FL
33813-2545
US

V. Phone/Fax

Practice location:
  • Phone: 863-619-2809
  • Fax:
Mailing address:
  • Phone: 863-242-1590
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-90746
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: