Healthcare Provider Details

I. General information

NPI: 1669713004
Provider Name (Legal Business Name): MAYELIN AGUILAR PEREZ M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/11/2013
Last Update Date: 10/09/2024
Certification Date: 10/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11044 DAWNVIEW LN
ORLANDO FL
32825-7421
US

IV. Provider business mailing address

11044 DAWNVIEW LN
ORLANDO FL
32825-7421
US

V. Phone/Fax

Practice location:
  • Phone: 407-486-0168
  • Fax:
Mailing address:
  • Phone: 407-305-1778
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH24229
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: