Provider Demographics
NPI:1447088943
Name:CEBALLOS, SARA WINNA
Entity type:Individual
Prefix:MISS
First Name:SARA
Middle Name:WINNA
Last Name:CEBALLOS
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 1:5510 N HIMES AVE APT 606
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-5773
Mailing Address - Country:US
Mailing Address - Phone:813-499-7340
Mailing Address - Fax:
Practice Address - Street 1:5510 N HIMES AVE APT 606
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-5773
Practice Address - Country:US
Practice Address - Phone:813-499-7340
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-25
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL24337070106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician