Healthcare Provider Details

I. General information

NPI: 1295412443
Provider Name (Legal Business Name): LEYDY FANO COTO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2023
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5461 W 24TH AVE APT 62
HIALEAH FL
33016-4706
US

IV. Provider business mailing address

6691 COW PEN RD APT A212
MIAMI LAKES FL
33014-6609
US

V. Phone/Fax

Practice location:
  • Phone: 786-914-0743
  • Fax:
Mailing address:
  • Phone: 786-914-0743
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBCBA-1-26-89575
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-23-276905
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: