MEDICARE: ROSELI PRUDENTE DOS SANTOS

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	RBT-26-508976	FL

General Provider Information

NPI Number	:	1528910221
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROSELI PRUDENTE DOS SANTOS

Provider Business Mailing Address
First Line	:	2110 STIRLING RD APT 203
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33020-1326
Country	:	US
Telephone Number	:	954-549-5197
Fax Number	:

Provider Business Practice Location Address
First Line	:	2110 STIRLING RD APT 203
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33020-1326
Country	:	US
Telephone Number	:	954-549-5197
Fax Number	:

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

Provider Enumeration Date	:	02/13/2026
Last Update Date	:	02/13/2026

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Directions to “ ROSELI PRUDENTE DOS SANTOS ” Practice Location

Language	Start Address	Practice Location

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