=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548123623
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | VINICIUS LUIZ GUIMARAES SEBASTIAO
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/05/2025
-----------------------------------------------------
Last Update Date | 12/05/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2576 S VOLUSIA AVE FL 32763
-----------------------------------------------------
City | ORANGE CITY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32763-9120
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 386-774-4840
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 681 ADDISON LONGWOOD TER APT 219
-----------------------------------------------------
City | LONGWOOD
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32750-5610
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101200000X
-----------------------------------------------------
Taxonomy Name | Drama Therapist
-----------------------------------------------------
License Number | PT44107
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------