Healthcare Provider Details

I. General information

NPI: 1619743622
Provider Name (Legal Business Name): CELESTE YEATTS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2023
Last Update Date: 11/30/2023
Certification Date: 11/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7333 INTERNATIONAL PL
LAKEWOOD RANCH FL
34240-8418
US

IV. Provider business mailing address

7333 INTERNATIONAL PL
LAKEWOOD RANCH FL
34240-8418
US

V. Phone/Fax

Practice location:
  • Phone: 941-907-3443
  • Fax: 941-527-0526
Mailing address:
  • Phone: 941-907-3443
  • Fax: 941-527-0526

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-23-306513
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: