Healthcare Provider Details

I. General information

NPI: 1841100831
Provider Name (Legal Business Name): ALEXANDRO EVANS DEOLIVEIRA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

413 SW 2ND ST
HALLANDALE BEACH FL
33009-5406
US

IV. Provider business mailing address

413 SW 2ND ST
HALLANDALE BEACH FL
33009-5406
US

V. Phone/Fax

Practice location:
  • Phone: 954-850-8566
  • Fax:
Mailing address:
  • Phone: 954-850-8566
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number1589453
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: