Healthcare Provider Details

I. General information

NPI: 1760165732
Provider Name (Legal Business Name): EDYLEIDY LLAMO VALIENTE RBT-23-287536
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2023
Last Update Date: 08/08/2023
Certification Date: 08/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13971 WINDRUSH CT APT 10
NORTH FORT MYERS FL
33903-4272
US

IV. Provider business mailing address

13971 WINDRUSH CT APT 10
NORTH FORT MYERS FL
33903-4272
US

V. Phone/Fax

Practice location:
  • Phone: 786-715-7762
  • Fax:
Mailing address:
  • Phone: 786-715-7762
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-23-287536
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: