MEDICARE: PEDRO FABIO LEAL RBT

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	:	1639968068
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PEDRO FABIO LEAL RBT

Provider Business Mailing Address
First Line	:	1020 DUNSON PARK BLVD UNIT 202
Second Line	:
City	:	DAVENPORT
State	:	FL
Zip	:	33896-7159
Country	:	US
Telephone Number	:	786-343-6204
Fax Number	:

Provider Business Practice Location Address
First Line	:	630 HERITAGE SQUARE DR
Second Line	:
City	:	HAINES CITY
State	:	FL
Zip	:	33844-7844
Country	:	US
Telephone Number	:	786-343-6204
Fax Number	:

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

Provider Enumeration Date	:	05/02/2025
Last Update Date	:	05/02/2025

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