Healthcare Provider Details

I. General information

NPI: 1679090674
Provider Name (Legal Business Name): YENNY FERNANDEZ LANDA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2017
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1129 PERSIMMON DR
HOLIDAY FL
34691-6714
US

IV. Provider business mailing address

1129 PERSIMMON DR
HOLIDAY FL
34691-6714
US

V. Phone/Fax

Practice location:
  • Phone: 727-648-0105
  • Fax:
Mailing address:
  • Phone: 727-648-0105
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: