Healthcare Provider Details

I. General information

NPI: 1487574380
Provider Name (Legal Business Name): CIARA CARABALLO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5196 MARINER BLVD
SPRING HILL FL
34609-1802
US

IV. Provider business mailing address

18930 LESTER LN UNIT 212
LAND O LAKES FL
34637-4744
US

V. Phone/Fax

Practice location:
  • Phone: 352-600-8300
  • Fax:
Mailing address:
  • Phone: 929-335-8206
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSI8936
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: