Healthcare Provider Details

I. General information

NPI: 1578010765
Provider Name (Legal Business Name): ANDREA PALERMO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2016
Last Update Date: 11/26/2024
Certification Date: 11/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10447 SW 108TH AVE APT E278
MIAMI FL
33176-8115
US

IV. Provider business mailing address

9601 SW 142ND AVE APT 624
MIAMI FL
33186-6862
US

V. Phone/Fax

Practice location:
  • Phone: 786-645-9900
  • Fax:
Mailing address:
  • Phone: 786-444-5172
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-17-38404
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: