Healthcare Provider Details

I. General information

NPI: 1205754439
Provider Name (Legal Business Name): SEBASTIAN CAMPO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2026
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1626 RIO COVE CT
ORLANDO FL
32825-8315
US

IV. Provider business mailing address

2546 WEMBLEYCROSS WAY
ORLANDO FL
32828-7961
US

V. Phone/Fax

Practice location:
  • Phone: 407-917-0416
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-25-474330
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: