Healthcare Provider Details

I. General information

NPI: 1720904907
Provider Name (Legal Business Name): ELIANA CEGLIO KENT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2026
Last Update Date: 06/24/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10272 S US HWY 1
PORT SAINT LUCIE FL
34952
US

IV. Provider business mailing address

434 SW NAMOIT PL
PORT SAINT LUCIE FL
34953-5991
US

V. Phone/Fax

Practice location:
  • Phone: 772-872-6940
  • Fax:
Mailing address:
  • Phone: 561-386-4616
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number1-08-4700
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: