Healthcare Provider Details

I. General information

NPI: 1588047633
Provider Name (Legal Business Name): ELEDYS CEDENO L.M.H.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELEDYS LABRADOR HERNANDEZ L.M.H.C.

II. Dates (important events)

Enumeration Date: 07/08/2015
Last Update Date: 10/06/2023
Certification Date: 10/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5595 S UNIVERSITY DR
DAVIE FL
33328-5307
US

IV. Provider business mailing address

2900 CORPORATE WAY DOOR D
MIRAMAR FL
33025-3925
US

V. Phone/Fax

Practice location:
  • Phone: 542-763-4009
  • Fax: 954-965-6444
Mailing address:
  • Phone: 954-276-5685
  • Fax: 954-985-7074

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH12532
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: