Healthcare Provider Details

I. General information

NPI: 1720916125
Provider Name (Legal Business Name): RACHELLY HERNANDEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2026
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

868 KILDARE ST E
LEHIGH ACRES FL
33974-7150
US

IV. Provider business mailing address

868 KILDARE ST E
LEHIGH ACRES FL
33974-7150
US

V. Phone/Fax

Practice location:
  • Phone: 239-202-4049
  • Fax:
Mailing address:
  • Phone: 239-202-4049
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBACB1563394
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: