Healthcare Provider Details

I. General information

NPI: 1255203055
Provider Name (Legal Business Name): MONIQUE RAVENELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2025
Last Update Date: 10/24/2025
Certification Date: 10/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7075 KINGSPOINTE PKWY STE 14
ORLANDO FL
32819-6542
US

IV. Provider business mailing address

2202 CASCADES BLVD UNIT 108
KISSIMMEE FL
34741-3481
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: