Healthcare Provider Details

I. General information

NPI: 1417676370
Provider Name (Legal Business Name): ALLISON MYERS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2022
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 SE HILLMOOR DR STE B101-103
PORT SAINT LUCIE FL
34952-7553
US

IV. Provider business mailing address

4700 DIXIE HWY NE APT 244
PALM BAY FL
32905-6089
US

V. Phone/Fax

Practice location:
  • Phone: 772-463-0444
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-2851374
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: