Provider Demographics
NPI:1083377782
Name:MENDEZ-GALEANO, MICHELLE (RBT)
Entity type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:
Last Name:MENDEZ-GALEANO
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:MRS
Other - First Name:MICHELLE
Other - Middle Name:
Other - Last Name:MENDEZ-GALEANO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RBT
Mailing Address - Street 1:13650 W COLONIAL DR STE 150
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-3994
Mailing Address - Country:US
Mailing Address - Phone:844-854-1116
Mailing Address - Fax:
Practice Address - Street 1:6000 TURKEY LAKE RD STE 114
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-4205
Practice Address - Country:US
Practice Address - Phone:321-732-3723
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-19
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL21-184811106S00000X
106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty