Healthcare Provider Details

I. General information

NPI: 1437745130
Provider Name (Legal Business Name): ISABELLE AHAL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2020
Last Update Date: 12/16/2020
Certification Date: 12/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

644 FERGUSON DR STE 200
ORLANDO FL
32805-1023
US

IV. Provider business mailing address

1400 MORGAN STANLEY AVE UNIT 216
WINTER PARK FL
32789-1983
US

V. Phone/Fax

Practice location:
  • Phone: 407-574-4629
  • Fax:
Mailing address:
  • Phone: 314-803-9332
  • 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: