MEDICARE: KEISHLA M TORRES-MALDONADO BCBA

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1124531769
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEISHLA M TORRES-MALDONADO BCBA

Provider Business Mailing Address
First Line	:	2424 W BRANDON BLVD # 1268
Second Line	:
City	:	BRANDON
State	:	FL
Zip	:	33511-4717
Country	:	US
Telephone Number	:	863-354-2715
Fax Number	:	813-354-2715

Provider Business Practice Location Address
First Line	:	304 E PINE ST # 1252
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33801-4969
Country	:	US
Telephone Number	:	813-602-0068
Fax Number	:	813-354-2715

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

Provider Enumeration Date	:	11/06/2017
Last Update Date	:	12/29/2025

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