Healthcare Provider Details

I. General information

NPI: 1023973740
Provider Name (Legal Business Name): ANISLEY CUETO PALACIOS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6936 HOLLY RD
MIAMI LAKES FL
33014-2669
US

IV. Provider business mailing address

6936 HOLLY RD
MIAMI LAKES FL
33014-2669
US

V. Phone/Fax

Practice location:
  • Phone: 786-644-2160
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-25499624
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: