Healthcare Provider Details

I. General information

NPI: 1518896307
Provider Name (Legal Business Name): KAYLA MARIE SORACCO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 09/29/2026
Certification Date: 05/18/2026
Deactivation Date: 05/18/2026
Reactivation Date: 09/29/2026

III. Provider practice location address

13 E MELBOURNE AVE STE D
MELBOURNE FL
32901-5976
US

IV. Provider business mailing address

413 PASTO CIR SW
PALM BAY FL
32908-3470
US

V. Phone/Fax

Practice location:
  • Phone: 321-677-2222
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberBACB1564173
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: