Healthcare Provider Details

I. General information

NPI: 1285331009
Provider Name (Legal Business Name): SIMONE PRATA COELHO REIS RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2023
Last Update Date: 02/13/2023
Certification Date: 02/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 W UNIVERSITY BLVD
MELBOURNE FL
32901-8995
US

IV. Provider business mailing address

3008 SAVANNAH WAY APT 203
MELBOURNE FL
32935-3647
US

V. Phone/Fax

Practice location:
  • Phone: 321-674-8106
  • Fax:
Mailing address:
  • Phone: 954-494-0608
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-22-239275
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: