Healthcare Provider Details

I. General information

NPI: 1790213072
Provider Name (Legal Business Name): MS. YANEIVY SERRANO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/31/2017
Last Update Date: 01/05/2026
Certification Date: 01/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5591 W 6TH CT
HIALEAH FL
33012-2545
US

IV. Provider business mailing address

5591 W 6TH CT
HIALEAH FL
33012-2545
US

V. Phone/Fax

Practice location:
  • Phone: 786-271-3023
  • Fax:
Mailing address:
  • Phone: 786-271-3023
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-25-86852
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: