Healthcare Provider Details

I. General information

NPI: 1053224527
Provider Name (Legal Business Name): ASTRID FABIOLA MIRANDA CORTES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2026
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5959 LAKE ELLENOR DR
ORLANDO FL
32809-4633
US

IV. Provider business mailing address

364 BANDON DUNES LOOP
DAVENPORT FL
33837-9727
US

V. Phone/Fax

Practice location:
  • Phone: 321-972-4039
  • Fax:
Mailing address:
  • Phone: 787-975-6614
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: