Healthcare Provider Details

I. General information

NPI: 1922914480
Provider Name (Legal Business Name): ANGELYSSE CHINIQUE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 E 3RD ST APT 201
HIALEAH FL
33010-4983
US

IV. Provider business mailing address

21 E 3RD ST APT 201
HIALEAH FL
33010-4983
US

V. Phone/Fax

Practice location:
  • Phone: 786-696-2907
  • Fax:
Mailing address:
  • Phone: 786-696-2907
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-26-2839931
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: