Healthcare Provider Details

I. General information

NPI: 1962391797
Provider Name (Legal Business Name): EDUARDO JULIAN CUELLO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2025
Last Update Date: 06/27/2025
Certification Date: 06/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 S PINE ISLAND RD STE 309
PLANTATION FL
33324-2669
US

IV. Provider business mailing address

10773 CLEARY BLVD APT 107
PLANTATION FL
33324-6065
US

V. Phone/Fax

Practice location:
  • Phone: 754-779-0656
  • Fax:
Mailing address:
  • Phone: 305-879-6390
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-25-440437
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: