MEDICARE: SERGIANE PINA TEIXEIRA BARROS

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-26-526705	FL

General Provider Information

NPI Number	:	1548102908
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SERGIANE PINA TEIXEIRA BARROS

Provider Business Mailing Address
First Line	:	2115 ROCK MAPLE BND
Second Line	:
City	:	KISSIMMEE
State	:	FL
Zip	:	34746-2433
Country	:	US
Telephone Number	:	407-744-6796
Fax Number	:	407-744-6796

Provider Business Practice Location Address
First Line	:	445 W OAK ST
Second Line	:
City	:	KISSIMMEE
State	:	FL
Zip	:	34741-6627
Country	:	US
Telephone Number	:	407-219-0402
Fax Number	:

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

Provider Enumeration Date	:	04/07/2026
Last Update Date	:	04/14/2026

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