Healthcare Provider Details

I. General information

NPI: 1902617756
Provider Name (Legal Business Name): BRIDNEY MEJIA VELASQUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/20/2025
Last Update Date: 01/20/2025
Certification Date: 01/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

708 GOODLETTE-FRANK RD N
NAPLES FL
34102-5644
US

IV. Provider business mailing address

5204 TREETOPS DR
NAPLES FL
34113-8507
US

V. Phone/Fax

Practice location:
  • Phone: 239-351-0675
  • Fax: 239-310-2045
Mailing address:
  • Phone: 239-384-1181
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-24-387974
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: