Healthcare Provider Details

I. General information

NPI: 1205714185
Provider Name (Legal Business Name): LISANDRA NIEVES ALFONSO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2025
Last Update Date: 03/17/2026
Certification Date: 03/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16851 NE 23RD AVE APT 519
NORTH MIAMI BEACH FL
33160-3731
US

IV. Provider business mailing address

16851 NE 23RD AVE APT 519
NORTH MIAMI BEACH FL
33160-3731
US

V. Phone/Fax

Practice location:
  • Phone: 786-521-2842
  • Fax:
Mailing address:
  • Phone: 786-521-2842
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-25-466225
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: