Healthcare Provider Details

I. General information

NPI: 1164198511
Provider Name (Legal Business Name): YORDANKA MEZAWI BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2021
Last Update Date: 08/17/2021
Certification Date: 07/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24298 SW 113 PSGE
HOMESTEAD FL
33032-3131
US

IV. Provider business mailing address

24298 SW 113 PSGE
HOMESTEAD FL
33032-3131
US

V. Phone/Fax

Practice location:
  • Phone: 786-202-1701
  • Fax:
Mailing address:
  • Phone: 786-202-1701
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBACB480273
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: