MEDICARE: KEYLA M ROSARIO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	BACB554207	FL

General Provider Information

NPI Number	:	1073182580
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEYLA M ROSARIO

Provider Business Mailing Address
First Line	:	11508 BALTIC ST
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32817-4437
Country	:	US
Telephone Number	:	407-535-6940
Fax Number	:

Provider Business Practice Location Address
First Line	:	14728 ROYAL POINCIANA DR
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32828-7329
Country	:	US
Telephone Number	:	407-416-0810
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/19/2021
Last Update Date	:	06/19/2021

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Directions to “ KEYLA M ROSARIO ” Practice Location

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