Healthcare Provider Details

I. General information

NPI: 1548073398
Provider Name (Legal Business Name): LIGNELL DANIELA CUELLO PEREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/27/2025
Last Update Date: 01/27/2025
Certification Date: 01/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6335 CONTESSA DR APT 104
ORLANDO FL
32829-8004
US

IV. Provider business mailing address

1627 E VINE ST STE 205D
KISSIMMEE FL
34744-3719
US

V. Phone/Fax

Practice location:
  • Phone: 407-683-1383
  • Fax:
Mailing address:
  • Phone: 407-577-8150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: