Healthcare Provider Details

I. General information

NPI: 1902200116
Provider Name (Legal Business Name): KALEIDOSCOPE INTERVENTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2014
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 E NASA BLVD
MELBOURNE FL
32901-1900
US

IV. Provider business mailing address

125 E NASA BLVD STE 104
MELBOURNE FL
32901-1900
US

V. Phone/Fax

Practice location:
  • Phone: 321-372-6813
  • Fax: 321-765-6434
Mailing address:
  • Phone: 321-265-4429
  • Fax: 321-765-6434

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: PAMELA FURR
Title or Position: CEO
Credential:
Phone: 321-372-6813