Healthcare Provider Details

I. General information

NPI: 1962124735
Provider Name (Legal Business Name): NAYANI ALEJO MEDINA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2022
Last Update Date: 05/03/2026
Certification Date: 05/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14310 SW 156TH TER
MIAMI FL
33177-1076
US

IV. Provider business mailing address

14310 SW 156TH TER
MIAMI FL
33177-1076
US

V. Phone/Fax

Practice location:
  • Phone: 203-963-0334
  • Fax:
Mailing address:
  • Phone: 203-963-0334
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBCBA1-26-89578
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: