MEDICARE: FREDLYNN J PERICLES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number State
1	106S00000X	Behavior Technician
2	310400000X	Assisted Living Facility
3	251E00000X	Home Health Agency	FL

General Provider Information

NPI Number	:	1851892764
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FREDLYNN J PERICLES

Provider Business Mailing Address
First Line	:	20110 NE 3RD CT
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33179-2962
Country	:	US
Telephone Number	:	786-230-7779
Fax Number	:

Provider Business Practice Location Address
First Line	:	4008 SW 23RD ST
Second Line	:
City	:	WEST PARK
State	:	FL
Zip	:	33023-3437
Country	:	US
Telephone Number	:	786-230-7779
Fax Number	:

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

Provider Enumeration Date	:	02/26/2018
Last Update Date	:	08/12/2025

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