Healthcare Provider Details

I. General information

NPI: 1376259424
Provider Name (Legal Business Name): HANIEL ROSELLO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2023
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9615 SW 24TH ST APT A309
MIAMI FL
33165-8043
US

IV. Provider business mailing address

9615 SW 24TH ST APT A309
MIAMI FL
33165-8043
US

V. Phone/Fax

Practice location:
  • Phone: 305-684-2550
  • Fax:
Mailing address:
  • Phone: 305-684-2550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-2854385
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-22-250565
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: