Basic Information
| Provider Information | |||||||||
| NPI: | 1033781430 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | INSANA | ||||||||
| FirstName: | CESILY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4997 ROYAL GULF CIR | ||||||||
| Address2: | |||||||||
| City: | FORT MYERS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 339667006 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2393135049 | ||||||||
| FaxNumber: | 2393135712 | ||||||||
| Practice Location | |||||||||
| Address1: | 4997 ROYAL GULF CIR | ||||||||
| Address2: | |||||||||
| City: | FORT MYERS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 339667006 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2393135049 | ||||||||
| FaxNumber: | 2393135712 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/14/2021 | ||||||||
| LastUpdateDate: | 07/14/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 07/14/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
ID Information
| ID | Type | State | Issuer | Description | SA19293 | 01 | FL | SLP FL LICENSE | OTHER |