Healthcare Provider Details

I. General information

NPI: 1326921495
Provider Name (Legal Business Name): M & A FAMILY CENTER CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2025
Last Update Date: 07/28/2025
Certification Date: 07/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3900 COLONIAL BLVD STE 3
FORT MYERS FL
33966-1014
US

IV. Provider business mailing address

3900 COLONIAL BLVD STE 3
FORT MYERS FL
33966-1014
US

V. Phone/Fax

Practice location:
  • Phone: 305-801-5769
  • Fax:
Mailing address:
  • Phone: 305-801-5769
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: ANDY PARADA MEDINA
Title or Position: PRESIDENT
Credential:
Phone: 305-801-5769