MEDICARE: NEILY MARTINEZ CANTILLO

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	1-26-90064	FL
2	106S00000X	Behavior Technician		FL

General Provider Information

NPI Number	:	1154186567
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NEILY MARTINEZ CANTILLO

Provider Business Mailing Address
First Line	:	11050 SW 70TH TER
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33173-2156
Country	:	US
Telephone Number	:	305-204-0647
Fax Number	:

Provider Business Practice Location Address
First Line	:	11050 SW 70TH TER
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33173-2156
Country	:	US
Telephone Number	:	305-204-0647
Fax Number	:

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

Provider Enumeration Date	:	02/15/2024
Last Update Date	:	06/01/2026

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Directions to “ NEILY MARTINEZ CANTILLO ” Practice Location

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