Healthcare Provider Details

I. General information

NPI: 1083377782
Provider Name (Legal Business Name): MICHELLE MENDEZ-GALEANO RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MICHELLE MENDEZ-GALEANO RBT

II. Dates (important events)

Enumeration Date: 10/19/2021
Last Update Date: 05/15/2024
Certification Date: 05/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6000 TURKEY LAKE RD STE 114
ORLANDO FL
32819-4205
US

IV. Provider business mailing address

13650 W COLONIAL DR STE 150
WINTER GARDEN FL
34787-3994
US

V. Phone/Fax

Practice location:
  • Phone: 321-732-3723
  • Fax:
Mailing address:
  • Phone: 844-854-1116
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number21-184811
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: