Healthcare Provider Details

I. General information

NPI: 1255185674
Provider Name (Legal Business Name): HEIDYS PRIETO PSY.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2024
Last Update Date: 08/21/2024
Certification Date: 08/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14400 NW 77TH CT
MIAMI LAKES FL
33016-1589
US

IV. Provider business mailing address

14400 NW 77TH CT
MIAMI LAKES FL
33016-1589
US

V. Phone/Fax

Practice location:
  • Phone: 305-653-5155
  • Fax:
Mailing address:
  • Phone: 305-653-5155
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number40302
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPY12135
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: