Healthcare Provider Details

I. General information

NPI: 1467234427
Provider Name (Legal Business Name): IDALY MONTANO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2023
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9750 NW 33RD ST SUITE 209
CORAL SPRINGS FL
33065
US

IV. Provider business mailing address

9750 NW 33RD ST SUITE 209
CORAL SPRINGS FL
33065
US

V. Phone/Fax

Practice location:
  • Phone: 954-509-3776
  • Fax: 954-827-0308
Mailing address:
  • Phone: 954-509-3776
  • Fax: 954-827-0308

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT23-302560
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License NumberSI8153
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: