Healthcare Provider Details

I. General information

NPI: 1790619385
Provider Name (Legal Business Name): STEPHANIE DARBOUZE
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4119 18TH ST SW
LEHIGH ACRES FL
33976-3206
US

IV. Provider business mailing address

4119 18TH ST SW
LEHIGH ACRES FL
33976-3206
US

V. Phone/Fax

Practice location:
  • Phone: 239-770-6228
  • Fax:
Mailing address:
  • Phone: 239-349-3139
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberBACB888279
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: