Healthcare Provider Details

I. General information

NPI: 1255063152
Provider Name (Legal Business Name): ISABELLE COLON ELJAIEK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ISABELLE COLON

II. Dates (important events)

Enumeration Date: 06/29/2022
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5453 SW 127TH CT
MIAMI FL
33175-6226
US

IV. Provider business mailing address

5453 SW 127TH CT
MIAMI FL
33175-6226
US

V. Phone/Fax

Practice location:
  • Phone: 689-280-2091
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number0-25-15842
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: