Healthcare Provider Details

I. General information

NPI: 1407720618
Provider Name (Legal Business Name): KYLA ELIZABETH LEVY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2025
Last Update Date: 10/01/2025
Certification Date: 10/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8487 9TH ST N
ST PETERSBURG FL
33702-3503
US

IV. Provider business mailing address

2555 NE 193RD ST UNIT 2120
MIAMI FL
33180-3473
US

V. Phone/Fax

Practice location:
  • Phone: 727-318-3224
  • Fax: 727-800-2333
Mailing address:
  • Phone: 305-409-2668
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-25-470304
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: