Healthcare Provider Details

I. General information

NPI: 1619599917
Provider Name (Legal Business Name): MIGUEL ALEJANDRO MACEDA HERNANDEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2020
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

132 SE 27TH ST
CAPE CORAL FL
33904-2724
US

IV. Provider business mailing address

132 SE 27TH ST
CAPE CORAL FL
33904-2724
US

V. Phone/Fax

Practice location:
  • Phone: 786-458-3087
  • Fax:
Mailing address:
  • Phone: 786-458-3087
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBCBA1-25-85914
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: