Provider Demographics
NPI:1891247516
Name:CEBALLO, LISA
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:CEBALLO
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 1:3406 70TH CT E
Mailing Address - Street 2:
Mailing Address - City:PALMETTO
Mailing Address - State:FL
Mailing Address - Zip Code:34221-7381
Mailing Address - Country:US
Mailing Address - Phone:631-766-7623
Mailing Address - Fax:
Practice Address - Street 1:3406 70TH CT E
Practice Address - Street 2:
Practice Address - City:PALMETTO
Practice Address - State:FL
Practice Address - Zip Code:34221-7381
Practice Address - Country:US
Practice Address - Phone:631-766-7623
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-28
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist