MEDICARE: LISANDRA NELSON BLANCO 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	RBT-25-428081	FL

General Provider Information

NPI Number	:	1821884859
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISANDRA NELSON BLANCO RBT

Provider Business Mailing Address
First Line	:	6008 W PARIS ST
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33634-5147
Country	:	US
Telephone Number	:	813-540-8151
Fax Number	:

Provider Business Practice Location Address
First Line	:	6008 W PARIS ST
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33634-5147
Country	:	US
Telephone Number	:	813-640-8151
Fax Number	:	813-640-8151

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

Provider Enumeration Date	:	04/16/2025
Last Update Date	:	04/16/2025

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