Healthcare Provider Details

I. General information

NPI: 1518859941
Provider Name (Legal Business Name): MS. KEVONNE FARQUHARSON
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2025
Last Update Date: 07/18/2025
Certification Date: 07/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3251 ENGINEERING ST
MELBOURNE FL
32901
US

IV. Provider business mailing address

4580 AMORE LN UNIT 101
MELBOURNE FL
32904-8519
US

V. Phone/Fax

Practice location:
  • Phone: 321-674-8106
  • Fax:
Mailing address:
  • Phone: 321-487-5771
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: