Healthcare Provider Details

I. General information

NPI: 1972161966
Provider Name (Legal Business Name): YADIRA LAVANDERA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2019
Last Update Date: 03/10/2026
Certification Date: 03/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6955 NW 186TH ST
HIALEAH FL
33015-3255
US

IV. Provider business mailing address

6955 NW 186TH ST
HIALEAH FL
33015-3255
US

V. Phone/Fax

Practice location:
  • Phone: 786-712-0012
  • Fax:
Mailing address:
  • Phone: 786-712-0012
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-18-65420
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-24-75598
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: