Provider Demographics
NPI:1396412409
Name:ACEBO, DAYRON
Entity Type:Individual
Prefix:
First Name:DAYRON
Middle Name:
Last Name:ACEBO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25350 SW 137TH AVE APT 102
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33032-5647
Mailing Address - Country:US
Mailing Address - Phone:786-205-7815
Mailing Address - Fax:
Practice Address - Street 1:91831 OVERSEAS HWY UNIT 11
Practice Address - Street 2:
Practice Address - City:TAVERNIER
Practice Address - State:FL
Practice Address - Zip Code:33070-2647
Practice Address - Country:US
Practice Address - Phone:305-998-4949
Practice Address - Fax:305-998-4680
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-26
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT20-123529106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician