Healthcare Provider Details

I. General information

NPI: 1043801459
Provider Name (Legal Business Name): YADEXY LEZCANO FERNANDEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/28/2021
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5555 GOLDEN GATE PKWY
NAPLES FL
34116-7573
US

IV. Provider business mailing address

2605 9TH ST SW
LEHIGH ACRES FL
33976-3127
US

V. Phone/Fax

Practice location:
  • Phone: 813-374-3906
  • Fax:
Mailing address:
  • Phone: 239-234-3294
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-89485
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: