Provider Demographics
NPI:1295622710
Name:REIS, FABIANA CRISTINA MELLO
Entity type:Individual
Prefix:
First Name:FABIANA
Middle Name:CRISTINA MELLO
Last Name:REIS
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 1:15381 SANDFIELD LOOP
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-9807
Mailing Address - Country:US
Mailing Address - Phone:516-784-7255
Mailing Address - Fax:
Practice Address - Street 1:15381 SANDFIELD LOOP
Practice Address - Street 2:
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-9807
Practice Address - Country:US
Practice Address - Phone:516-784-7255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-18
Last Update Date:2025-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
FL222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
No174400000XOther Service ProvidersSpecialist