MEDICARE: ANNELIS FERNANDEZ PEDROSO

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	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1528904554
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNELIS FERNANDEZ PEDROSO

Provider Business Mailing Address
First Line	:	616 CLEARWATER PARK RD APT 1113
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33401-6250
Country	:	US
Telephone Number	:	561-719-6454
Fax Number	:

Provider Business Practice Location Address
First Line	:	616 CLEARWATER PARK RD APT 1113
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33401-6250
Country	:	US
Telephone Number	:	561-719-6454
Fax Number	:

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

Provider Enumeration Date	:	04/23/2026
Last Update Date	:	04/23/2026

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