Provider Demographics
NPI:1194308270
Name:CARABALLO, DEYSHLA
Entity type:Individual
Prefix:
First Name:DEYSHLA
Middle Name:
Last Name:CARABALLO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:735 MAIN LN APT 3309
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32801-3765
Mailing Address - Country:US
Mailing Address - Phone:407-808-2305
Mailing Address - Fax:
Practice Address - Street 1:735 MAIN LN APT 3309
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32801-3765
Practice Address - Country:US
Practice Address - Phone:407-808-2305
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-05
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health